Provider Demographics
NPI:1700622396
Name:SANTOS, MONIQUE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
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 1:305 DAHOON HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7121
Mailing Address - Country:US
Mailing Address - Phone:386-317-1732
Mailing Address - Fax:
Practice Address - Street 1:1408 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4020
Practice Address - Country:US
Practice Address - Phone:352-373-4411
Practice Address - Fax:352-373-4455
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician