Provider Demographics
NPI:1013659796
Name:SANTANA, THERESE ANGEL (ND)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:ANGEL
Last Name:SANTANA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2077
Mailing Address - Country:US
Mailing Address - Phone:206-565-7047
Mailing Address - Fax:
Practice Address - Street 1:59 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2077
Practice Address - Country:US
Practice Address - Phone:206-565-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5038175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty