Healthcare Provider Details

I. General information

NPI: 1043987688
Provider Name (Legal Business Name): PHILLINE YVONNE M SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 LA TIJERA BLVD
LOS ANGELES CA
90045-3944
US

IV. Provider business mailing address

38 SILVER SPRING DR
ROLLING HILLS ESTATES CA
90274-2312
US

V. Phone/Fax

Practice location:
  • Phone: 310-265-3389
  • Fax:
Mailing address:
  • Phone: 310-265-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: