Healthcare Provider Details

I. General information

NPI: 1659967446
Provider Name (Legal Business Name): JULISSA ESTHER SANTOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 WILSHIRE BLVD FL 19
LOS ANGELES CA
90048-4920
US

IV. Provider business mailing address

3535 MERCURY DR
SANTA MARIA CA
93455-2622
US

V. Phone/Fax

Practice location:
  • Phone: 805-764-9651
  • Fax: 747-330-1670
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: