Provider Demographics
NPI:1457098824
Name:DE LOS SANTOS, HECTOR FRANCISCO
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:FRANCISCO
Last Name:DE LOS SANTOS
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 1:1 SAINT JOSEPH AVE APT D
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3179
Mailing Address - Country:US
Mailing Address - Phone:949-293-8198
Mailing Address - Fax:
Practice Address - Street 1:20377 SW ACACIA ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0780
Practice Address - Country:US
Practice Address - Phone:949-237-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical