Provider Demographics
NPI:1407420144
Name:DOS SANTOS, LETICIA
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:DOS SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:DOS SANTOS
Other - Last Name:GEISSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5801 NE CORNELIUS PASS RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9370
Mailing Address - Country:US
Mailing Address - Phone:971-762-1144
Mailing Address - Fax:
Practice Address - Street 1:5801 NE CORNELIUS PASS RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9370
Practice Address - Country:US
Practice Address - Phone:971-762-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician