Healthcare Provider Details

I. General information

NPI: 1851023030
Provider Name (Legal Business Name): JUSTIN SANTOS MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16800 ASTON
IRVINE CA
92606-4812
US

IV. Provider business mailing address

7821 KELLY CIR
LA PALMA CA
90623-1646
US

V. Phone/Fax

Practice location:
  • Phone: 949-748-8571
  • Fax:
Mailing address:
  • Phone: 562-412-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: