Provider Demographics
NPI:1164197844
Name:SANTANA, ROBERT JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:SANTANA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4313
Mailing Address - Country:US
Mailing Address - Phone:714-450-5737
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMBELL BLVD 130A
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-9283
Practice Address - Country:US
Practice Address - Phone:714-450-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD285192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine