Healthcare Provider Details

I. General information

NPI: 1366838195
Provider Name (Legal Business Name): EMMANUEL SANTANA LCSW 79744
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 CHESTER ST
LOS ANGELES CA
90032-3020
US

IV. Provider business mailing address

5119 CHESTER ST
LOS ANGELES CA
90032-3020
US

V. Phone/Fax

Practice location:
  • Phone: 323-380-8830
  • Fax:
Mailing address:
  • Phone: 323-380-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: