Individual
MICHELLE DOMINIQUE DE SANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1001 S GARFIELD AVE, ALHAMBRA, CA 91801-4772
(818) 788-4513
Mailing address
1001 S GARFIELD AVE, ALHAMBRA, CA 91801-4772
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20A12005
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A12005
OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
CA
Enumeration date
12/05/2011
Last updated
12/27/2021
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