Healthcare Provider Details

I. General information

NPI: 1144158445
Provider Name (Legal Business Name): SARA ANN SANTIBANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 E HAYWARD AVE
PHOENIX AZ
85020-4042
US

IV. Provider business mailing address

526 E HAYWARD AVE
PHOENIX AZ
85020-4042
US

V. Phone/Fax

Practice location:
  • Phone: 602-822-2658
  • Fax:
Mailing address:
  • Phone: 602-822-2658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number096042
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: