Provider Demographics
NPI:1417634189
Name:SANTANA, ALEJANDRA (LMT, LE)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LMT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-2055
Mailing Address - Country:US
Mailing Address - Phone:970-380-7165
Mailing Address - Fax:
Practice Address - Street 1:36 S 18TH AVE STE B
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2452
Practice Address - Country:US
Practice Address - Phone:720-864-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015781225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist