Provider Demographics
NPI:1982057188
Name:SANTOS, JENNISH (RRT, RCP)
Entity Type:Individual
Prefix:
First Name:JENNISH
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 S GAFFEY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4062
Mailing Address - Country:US
Mailing Address - Phone:310-347-7553
Mailing Address - Fax:
Practice Address - Street 1:1337 S GAFFEY ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-4062
Practice Address - Country:US
Practice Address - Phone:310-347-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24862227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered