Provider Demographics
NPI:1689367039
Name:SANTOS, HEIDI (CMT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3404
Mailing Address - Country:US
Mailing Address - Phone:310-422-7965
Mailing Address - Fax:
Practice Address - Street 1:1965 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-5817
Practice Address - Country:US
Practice Address - Phone:310-422-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 374K00000X
CA76117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner