Healthcare Provider Details

I. General information

NPI: 1225779994
Provider Name (Legal Business Name): CARA ISOBEL SANTIANO BUENAVENTURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8673 W PICO BLVD
LOS ANGELES CA
90035-2377
US

IV. Provider business mailing address

17154 INDEX ST
GRANADA HILLS CA
91344-4133
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3981
  • Fax:
Mailing address:
  • Phone: 818-203-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: