MEDICARE: MR. JOHN SANTOS MS,CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SP 16754	CA

General Provider Information

NPI Number	:	1639567548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN SANTOS MS,CCC-SLP

Provider Business Mailing Address
First Line	:	401 SOUTH NORFOLK ST.
Second Line	:	#205
City	:	SAN MATEO
State	:	CA
Zip	:	94401
Country	:	US
Telephone Number	:	510-289-3965
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S NORFOLK ST
Second Line	:	#205
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3074
Country	:	US
Telephone Number	:	510-289-3965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	06/02/2022

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