Provider Demographics
NPI:1508980475
Name:SANTOS, RAINIER P
Entity Type:Individual
Prefix:
First Name:RAINIER
Middle Name:P
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMMOND STE C
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1680
Mailing Address - Country:US
Mailing Address - Phone:949-770-6022
Mailing Address - Fax:949-770-7084
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:#119
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-595-8635
Practice Address - Fax:949-535-8639
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT33093OtherTHERAPIST LICENSE