Provider Demographics
NPI:1902252216
Name:SANTOS, ERNEST CALLERA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:CALLERA
Last Name:SANTOS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 SEAL BEACH BLVD STE B530
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2792
Mailing Address - Country:US
Mailing Address - Phone:562-268-5314
Mailing Address - Fax:562-661-9750
Practice Address - Street 1:12340 SEAL BEACH BLVD STE B530
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2792
Practice Address - Country:US
Practice Address - Phone:562-268-5314
Practice Address - Fax:562-661-9750
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8768225XR0403X, 225X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist