Healthcare Provider Details

I. General information

NPI: 1528199437
Provider Name (Legal Business Name): ERICA C SANTAMARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 WEST BASELINE ROAD
LA VERNE CA
91750
US

IV. Provider business mailing address

P.O BOX 400 233 WEST BASELINE ROAD
LA VERNE CA
91750
US

V. Phone/Fax

Practice location:
  • Phone: 909-593-2581
  • Fax: 909-596-3567
Mailing address:
  • Phone: 909-593-2581
  • Fax: 909-596-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: