Provider Demographics
NPI:1174989578
Name:SANTOS, AISHA MARPA (LVN/LPN)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:MARPA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LVN/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 STARSTONE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7899
Mailing Address - Country:US
Mailing Address - Phone:805-407-0330
Mailing Address - Fax:
Practice Address - Street 1:1219 STARSTONE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7899
Practice Address - Country:US
Practice Address - Phone:805-407-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251166323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility