Healthcare Provider Details

I. General information

NPI: 1053168757
Provider Name (Legal Business Name): ELOY SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S DALE AVE
ANAHEIM CA
92804-4097
US

IV. Provider business mailing address

324 E ALBERTA ST
ANAHEIM CA
92805-2727
US

V. Phone/Fax

Practice location:
  • Phone: 714-220-4210
  • Fax:
Mailing address:
  • Phone: 714-348-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number119721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: