Provider Demographics
NPI:1780261016
Name:SANTANDER, DAVID (LAC, DTCM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANTANDER
Suffix:
Gender:M
Credentials:LAC, DTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AMY TODT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3724
Mailing Address - Country:US
Mailing Address - Phone:845-781-6963
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST STE 303
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2533
Practice Address - Country:US
Practice Address - Phone:808-501-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006895171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist