Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ACSW94155 | CA |
NPI | 1003445206 |
---|---|
Provider Name | Angie Marie Santos |
First Address | Long Beach, CA 90810-1878 |
Second Address | Long Beach, CA 90810-1878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 08/04/2020 |