Healthcare Provider Details

I. General information

NPI: 1033307103
Provider Name (Legal Business Name): GERARDO BARAJAS SANTILLAN RN,MA,BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GERARDO BARAJAS SANTILLAN RN,MA,BS

II. Dates (important events)

Enumeration Date: 10/13/2007
Last Update Date: 10/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9237 VENTANA LN
NORTH HILLS CA
91343-3478
US

IV. Provider business mailing address

9237 VENTANA LN
NORTH HILLS CA
91343-3478
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-9616
  • Fax:
Mailing address:
  • Phone: 818-456-9616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number699278
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number699278
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number699278
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number699278
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number699278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: