Healthcare Provider Details

I. General information

NPI: 1760398895
Provider Name (Legal Business Name): DIANA SANTILLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 66TH AVE
OAKLAND CA
94621-3506
US

IV. Provider business mailing address

6240 BROMLEY AVE
OAKLAND CA
94621-3848
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberEB3E12BB9C
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: