Healthcare Provider Details

I. General information

NPI: 1225518988
Provider Name (Legal Business Name): DANIELLE SANTOS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E 16TH ST
COSTA MESA CA
92627-7704
US

IV. Provider business mailing address

16691 BARTLETT LN APT 1
HUNTINGTON BEACH CA
92647-8550
US

V. Phone/Fax

Practice location:
  • Phone: 562-661-8578
  • Fax:
Mailing address:
  • Phone: 562-661-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number13926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: