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General NPI Number Information
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NPI Number | 1801354436
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Entity Type | Individual
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Provider Name | ANDREA MICHELLE DE LOS SANTOS
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Gender | Female
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Dates
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Enumeration Date | 03/02/2019
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Last Update Date | 03/02/2019
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Provider Practice Location Address
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Address Line | 4530 BELTWAY DR
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City | ADDISON
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State | TX
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Zip | 75001-3707
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Country | US
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Telephone | 214-636-0871
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Fax |
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Provider Business Mailing Address
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Address Line | 3329 PARSONS RD
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City | VICTORIA
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State | TX
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Zip | 77904-4759
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Country | US
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Telephone | 619-359-6463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 115062
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License Number State | TX
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