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NPI Code Detail

MEDICARE: OLGA SANTOS

MEDICARE: OLGA SANTOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1396931218
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLGA SANTOS
Provider Business Mailing Address
First Line : 646 N H ST
Second Line :
City : LOMPOC
State : CA
Zip : 93436-4519
Country : US
Telephone Number : 805-865-1950
Fax Number : 805-865-1955
Provider Business Practice Location Address
First Line : 646 N H ST
Second Line :
City : LOMPOC
State : CA
Zip : 93436-4519
Country : US
Telephone Number : 805-865-1950
Fax Number : 805-865-1955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2007
Last Update Date : 09/25/2007

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Directions to “ OLGA SANTOS ” Practice Location

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