Healthcare Provider Details

I. General information

NPI: 1447885058
Provider Name (Legal Business Name): ERICK SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S RAYMOND AVE
PASADENA CA
91105-3229
US

IV. Provider business mailing address

1801 ORANGE TREE LN STE 200
REDLANDS CA
92374-4587
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-1285
  • Fax:
Mailing address:
  • Phone: 323-450-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: