Provider Demographics
NPI:1679693071
Name:DELOS SANTOS, LORI MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:MARIA
Last Name:DELOS SANTOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 LEGION LANE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039
Mailing Address - Country:US
Mailing Address - Phone:213-321-9661
Mailing Address - Fax:
Practice Address - Street 1:19700 S VERMONT AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1100
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18106OtherPSYCHOLOGIST