Provider Demographics
NPI:1497287569
Name:SANTOS, JESSICA AIDA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AIDA
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 1:791 N PINE ISLAND RD APT 202
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1325
Mailing Address - Country:US
Mailing Address - Phone:347-361-4237
Mailing Address - Fax:
Practice Address - Street 1:1021 SE 7TH AVE
Practice Address - Street 2:APT 204
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-5365
Practice Address - Country:US
Practice Address - Phone:347-361-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician