Provider Demographics
NPI:1407564412
Name:SANTOS, JULIA LYNNE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNNE
Last Name: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 1:6 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1917
Mailing Address - Country:US
Mailing Address - Phone:401-465-8567
Mailing Address - Fax:
Practice Address - Street 1:664 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3537
Practice Address - Country:US
Practice Address - Phone:617-524-4620
Practice Address - Fax:617-983-1658
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program