Healthcare Provider Details

I. General information

NPI: 1538437702
Provider Name (Legal Business Name): MR. JOSE SANTANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 AIRWAY AVE., UNIT F
COSTA MESA CA
92626
US

IV. Provider business mailing address

10253 OTIS ST
SOUTH GATE CA
90280-6717
US

V. Phone/Fax

Practice location:
  • Phone: 714-689-1380
  • Fax: 714-689-1381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: