Provider Demographics
NPI:1881240125
Name:DE LOS SANTOS, JOLUIS (DPT)
Entity type:Individual
Prefix:
First Name:JOLUIS
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4023
Mailing Address - Country:US
Mailing Address - Phone:310-937-2323
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE ST STE 71
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1560
Practice Address - Country:US
Practice Address - Phone:914-478-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297795225100000X
NY044481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty