Provider Demographics
NPI:1790565067
Name:SANTANA, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:SANTANA
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 1:100 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-1383
Mailing Address - Country:US
Mailing Address - Phone:833-282-2223
Mailing Address - Fax:
Practice Address - Street 1:100 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-1383
Practice Address - Country:US
Practice Address - Phone:833-282-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician