Provider Demographics
NPI:1447138250
Name:SANTOS, JOSEPHINE CLARISSE
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:CLARISSE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 CENTURY BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-8604
Mailing Address - Country:US
Mailing Address - Phone:310-493-9508
Mailing Address - Fax:
Practice Address - Street 1:8524 CENTURY BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-8604
Practice Address - Country:US
Practice Address - Phone:310-493-9508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily