Provider Demographics
NPI:1275036675
Name:DE SANTOS, GUADALUPE VERONICA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:VERONICA
Last Name:DE SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 PACIFIC BLVD STE A&B
Mailing Address - Street 2:
Mailing Address - City:WALNUT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5739
Mailing Address - Country:US
Mailing Address - Phone:323-538-9050
Mailing Address - Fax:
Practice Address - Street 1:7400 PACIFIC BLVD STE A&B
Practice Address - Street 2:
Practice Address - City:WALNUT PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5739
Practice Address - Country:US
Practice Address - Phone:323-538-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician