Healthcare Provider Details

I. General information

NPI: 1194541839
Provider Name (Legal Business Name): JULIE ANN THERESE DE LOS SANTOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ANN THERESE P DE LOS SANTOS NP

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

IV. Provider business mailing address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

V. Phone/Fax

Practice location:
  • Phone: 310-691-0194
  • Fax:
Mailing address:
  • Phone: 530-691-0194
  • Fax: 310-943-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95032208
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95248205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: