Provider Demographics
NPI:1689306011
Name:SANTOS, NICHOLAS J (RKT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:SANTOS
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 ALBURY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2541
Mailing Address - Country:US
Mailing Address - Phone:562-756-7512
Mailing Address - Fax:
Practice Address - Street 1:4508 ALBURY AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-2541
Practice Address - Country:US
Practice Address - Phone:562-756-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation