Healthcare Provider Details

I. General information

NPI: 1306492368
Provider Name (Legal Business Name): ROVIN SANTOS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD
LOS ANGELES CA
90010-2501
US

IV. Provider business mailing address

3580 WILSHIRE BLVD
LOS ANGELES CA
90010-2501
US

V. Phone/Fax

Practice location:
  • Phone: 213-296-3783
  • Fax:
Mailing address:
  • Phone: 213-296-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019246
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95183237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: