Healthcare Provider Details

I. General information

NPI: 1295669307
Provider Name (Legal Business Name): ERNESTO BLANCO SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E CYPRESS ST
COVINA CA
91723-1344
US

IV. Provider business mailing address

570 E CYPRESS ST
COVINA CA
91723-1344
US

V. Phone/Fax

Practice location:
  • Phone: 626-956-3422
  • Fax:
Mailing address:
  • Phone: 626-956-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number97670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: