Provider Demographics
NPI:1073809265
Name:SANTORO, STEFFAN ANTHONY (LAC)
Entity Type:Individual
Prefix:MR
First Name:STEFFAN
Middle Name:ANTHONY
Last Name:SANTORO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5624
Mailing Address - Country:US
Mailing Address - Phone:808-937-7935
Mailing Address - Fax:
Practice Address - Street 1:1201 W COURT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5624
Practice Address - Country:US
Practice Address - Phone:808-937-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13731171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist