Healthcare Provider Details

I. General information

NPI: 1205005873
Provider Name (Legal Business Name): MELISSA L SANTILLANA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N DOUTY ST
HANFORD CA
93230-3722
US

IV. Provider business mailing address

1025 NORTH DOUTY
HANFORD CA
92320
US

V. Phone/Fax

Practice location:
  • Phone: 559-583-2142
  • Fax: 559-583-7989
Mailing address:
  • Phone: 559-583-2142
  • Fax: 559-583-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number608728
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: