Provider Demographics
NPI:1336756782
Name:SANTOSUOSSO, MOLLY (NMD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:SANTOSUOSSO
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 E LONGHORN PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1514
Mailing Address - Country:US
Mailing Address - Phone:978-944-3863
Mailing Address - Fax:
Practice Address - Street 1:2164 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1766
Practice Address - Country:US
Practice Address - Phone:480-970-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-1897175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty