Healthcare Provider Details

I. General information

NPI: 1902764509
Provider Name (Legal Business Name): ALEXANDRIA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

IV. Provider business mailing address

3835 ACKERMAN DR
LOS ANGELES CA
90065-3540
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95041374
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95348723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: