Provider Demographics
NPI:1477247484
Name:DOS SANTOS, ISABELLA MATTOS
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MATTOS
Last Name:DOS 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 1:1850 14TH ST SW
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-2921
Mailing Address - Country:US
Mailing Address - Phone:330-322-4401
Mailing Address - Fax:
Practice Address - Street 1:597 KILLIAN RD
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-2525
Practice Address - Country:US
Practice Address - Phone:330-322-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program