Healthcare Provider Details

I. General information

NPI: 1285563221
Provider Name (Legal Business Name): JOANNE SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23921 SAPPHIRE CANYON RD
DIAMOND BAR CA
91765-1141
US

IV. Provider business mailing address

23921 SAPPHIRE CANYON RD
DIAMOND BAR CA
91765-1141
US

V. Phone/Fax

Practice location:
  • Phone: 909-800-4799
  • Fax:
Mailing address:
  • Phone: 909-800-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: