Provider Demographics
NPI:1245411883
Name:SANTOS, AXEL ANIBAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:AXEL
Middle Name:ANIBAL
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 5911
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-9834
Mailing Address - Country:US
Mailing Address - Phone:787-390-9830
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3647
Practice Address - Country:US
Practice Address - Phone:787-390-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical