MEDICARE: DR. HEATHER KAPLAN-SANTOS PH.D.

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	103TP2701X	Group Psychotherapy Psychologist	PSY32531	CA
2	103TC0700X	Clinical Psychologist	PSY32531	CA

General Provider Information

NPI Number	:	1639751969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER KAPLAN-SANTOS PH.D.

Provider Business Mailing Address
First Line	:	30211 AVENIDA DE LAS BANDERAS, SUITE 200
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688
Country	:	US
Telephone Number	:	949-409-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	30211 AVENIDA DE LAS BANDERAS, SUITE 200
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-9268
Country	:	US
Telephone Number	:	949-409-5075
Fax Number	:

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

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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