Healthcare Provider Details

I. General information

NPI: 1790081339
Provider Name (Legal Business Name): SANDRA ISABEL SANTOS OTR/L, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2011
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 HAWK ST APT 1
SAN DIEGO CA
92103-1822
US

IV. Provider business mailing address

4019 HAWK ST APT 1
SAN DIEGO CA
92103-1822
US

V. Phone/Fax

Practice location:
  • Phone: 915-252-9265
  • Fax:
Mailing address:
  • Phone: 915-252-9265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number015187
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number015187
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number015187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: