Provider Demographics
NPI:1780497636
Name:DE LOS SANTOS, EDWIN
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
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:URB. LOS COLOBOS PARK
Mailing Address - Street 2:715, CALLE MALAGUETA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8338
Mailing Address - Country:US
Mailing Address - Phone:787-664-1680
Mailing Address - Fax:
Practice Address - Street 1:URB. LOS COLOBOS PARK
Practice Address - Street 2:715, CALLE MALAGUETA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8338
Practice Address - Country:US
Practice Address - Phone:787-664-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician