Provider Demographics
NPI:1023563111
Name:SANTOS, SANDY KHRISTINE (LVN)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:KHRISTINE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 KERN MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7817
Mailing Address - Country:US
Mailing Address - Phone:925-550-0163
Mailing Address - Fax:
Practice Address - Street 1:1711 KERN MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7817
Practice Address - Country:US
Practice Address - Phone:925-550-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN250754164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse