MEDICARE: TEA DE LOS 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
1	106S00000X	Behavior Technician		IL

General Provider Information

NPI Number	:	1669331989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEA DE LOS SANTOS

Provider Business Mailing Address
First Line	:	2930 5TH AVE APT 11
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-1910
Country	:	US
Telephone Number	:	509-270-3789
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 W KIMBERLY RD STE 46
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52806-5717
Country	:	US
Telephone Number	:	562-262-8543
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ TEA DE LOS SANTOS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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