Provider Demographics
NPI:1225518988
Name:SANTOS, DANIELLE (MT-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16691 BARTLETT LN APT 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-8550
Mailing Address - Country:US
Mailing Address - Phone:562-661-8578
Mailing Address - Fax:
Practice Address - Street 1:126 E 16TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7704
Practice Address - Country:US
Practice Address - Phone:562-661-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13926225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist