Healthcare Provider Details

I. General information

NPI: 1548198625
Provider Name (Legal Business Name): MYLA MARIE SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYLA MARIE NIMMO

II. Dates (important events)

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

III. Provider practice location address

11950 STEEPLECHASE DR
MORENO VALLEY CA
92555-1750
US

IV. Provider business mailing address

11950 STEEPLECHASE DR
MORENO VALLEY CA
92555-1750
US

V. Phone/Fax

Practice location:
  • Phone: 951-485-6999
  • Fax:
Mailing address:
  • Phone: 951-485-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: