Provider Demographics
NPI:1376369066
Name:DELOS SANTOS, KEITHLENE VHIE LEGASPI
Entity type:Individual
Prefix:
First Name:KEITHLENE VHIE
Middle Name:LEGASPI
Last Name:DELOS 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 1:160 S OLD SPRINGS RD STE 240A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1260
Mailing Address - Country:US
Mailing Address - Phone:808-589-8117
Mailing Address - Fax:
Practice Address - Street 1:160 S OLD SPRINGS RD STE 240A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1260
Practice Address - Country:US
Practice Address - Phone:657-363-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA795867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse