Provider Demographics
NPI:1164937934
Name:SANTOS, HECTOR LUIS
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:LUIS
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13509 S INDIAN RIVER DR APT 406
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2262
Mailing Address - Country:US
Mailing Address - Phone:772-418-7663
Mailing Address - Fax:
Practice Address - Street 1:13509 S INDIAN RIVER DR APT 406
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-2262
Practice Address - Country:US
Practice Address - Phone:772-418-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant