Healthcare Provider Details

I. General information

NPI: 1669990727
Provider Name (Legal Business Name): YASMIN A SANTOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST
BRIGHTON MA
02135
US

IV. Provider business mailing address

77 WARREN ST
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-1271
  • Fax:
Mailing address:
  • Phone: 617-254-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN2318100
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: