Healthcare Provider Details

I. General information

NPI: 1417843418
Provider Name (Legal Business Name): JONATHAN ABRAHAM DE SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10331 STANFORD AVE
GARDEN GROVE CA
92840-6351
US

IV. Provider business mailing address

10331 STANFORD AVE
GARDEN GROVE CA
92840-6351
US

V. Phone/Fax

Practice location:
  • Phone: 714-663-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number131536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: