Provider Demographics
NPI:1770972424
Name:DOS SANTOS, RAQUEL MORAES (OTA/L)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MORAES
Last Name:DOS SANTOS
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11283
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-1283
Mailing Address - Country:US
Mailing Address - Phone:714-287-3595
Mailing Address - Fax:
Practice Address - Street 1:1929 N FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2205
Practice Address - Country:US
Practice Address - Phone:714-287-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1811224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant