Healthcare Provider Details

I. General information

NPI: 1497480552
Provider Name (Legal Business Name): JASON SANTELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S NEW HAMPSHIRE AVE # 400
LOS ANGELES CA
90005-1355
US

IV. Provider business mailing address

2053 1/4 NORWALK AVE
LOS ANGELES CA
90041-2725
US

V. Phone/Fax

Practice location:
  • Phone: 626-753-5342
  • Fax:
Mailing address:
  • Phone: 323-397-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW131345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: