Provider Demographics
NPI:1013614122
Name:SANTOS, KEVIN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 KANSAS ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2967
Mailing Address - Country:US
Mailing Address - Phone:862-703-6234
Mailing Address - Fax:
Practice Address - Street 1:3993 KANSAS ST APT 9
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2967
Practice Address - Country:US
Practice Address - Phone:862-703-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021879363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health