Healthcare Provider Details

I. General information

NPI: 1396456471
Provider Name (Legal Business Name): AHLANI SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 GALILEO CT STE 101
DAVIS CA
95618-4882
US

IV. Provider business mailing address

1947 GALILEO CT STE 101
DAVIS CA
95618-4882
US

V. Phone/Fax

Practice location:
  • Phone: 530-220-1450
  • Fax:
Mailing address:
  • Phone: 530-220-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-527081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: