MEDICARE: ELIZABETH G. SANTOS, INC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		CA

General Provider Information

NPI Number	:	1730518895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH G. SANTOS, INC

Provider Business Mailing Address
First Line	:	6287 SAN RICARDO WAY
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2845
Country	:	US
Telephone Number	:	714-527-9145
Fax Number	:	714-736-0931

Provider Business Practice Location Address
First Line	:	6051 SAN YSIDRO CIR
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2849
Country	:	US
Telephone Number	:	714-527-9145
Fax Number	:	714-736-0931

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ELIZABETH G SANTOS
Credential	:	BSE
Telephone Number	:	714-828-0465

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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