Provider Demographics
NPI:1760514475
Name:SANTOS, GLENDA LAUREN
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LAUREN
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 1:7410 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-2034
Mailing Address - Country:US
Mailing Address - Phone:323-541-9016
Mailing Address - Fax:323-541-9192
Practice Address - Street 1:2770 S MARYLAND PKWY STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1564
Practice Address - Country:US
Practice Address - Phone:702-463-7779
Practice Address - Fax:702-778-4226
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner