Provider Demographics
NPI:1467720748
Name:DE LOS SANTOS, MARIANA (BCABA)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 ISOM RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4026
Mailing Address - Country:US
Mailing Address - Phone:210-415-9626
Mailing Address - Fax:866-936-4614
Practice Address - Street 1:722 ISOM RD STE A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4026
Practice Address - Country:US
Practice Address - Phone:210-415-9626
Practice Address - Fax:866-936-4615
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-11-4334103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst