Healthcare Provider Details

I. General information

NPI: 1851156517
Provider Name (Legal Business Name): GUADALUPE SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E COOLEY DR
COLTON CA
92324-3905
US

IV. Provider business mailing address

1330 E COOLEY DR
COLTON CA
92324-3905
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3705
  • Fax: 909-580-3747
Mailing address:
  • Phone: 909-580-3705
  • Fax: 909-580-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: