Healthcare Provider Details

I. General information

NPI: 1679462113
Provider Name (Legal Business Name): DANIELLA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

520 S MAIN ST UNIT A
BELTON TX
76513-3462
US

IV. Provider business mailing address

520 S MAIN ST UNIT A
BELTON TX
76513-3462
US

V. Phone/Fax

Practice location:
  • Phone: 254-863-2611
  • Fax: 254-863-2611
Mailing address:
  • Phone: 254-863-2611
  • Fax: 254-863-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: