MEDICARE: JAMELA SANTOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF-123	GU
2	101YP2500X	Professional Counselor	LPC-123	GU

General Provider Information

NPI Number	:	1194165670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMELA SANTOS

Provider Business Mailing Address
First Line	:	104 FEDERICO ST
Second Line	:
City	:	MANGILAO
State	:	GU
Zip	:	96913-5768
Country	:	US
Telephone Number	:	671-646-5748
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 LEON GUERRERO DRIVE
Second Line	:
City	:	TUMON
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-646-5748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	12/08/2021

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Directions to “ JAMELA SANTOS ” Practice Location

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