Healthcare Provider Details

I. General information

NPI: 1124926456
Provider Name (Legal Business Name): DIANA SANDRA SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2026
Last Update Date: 10/27/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4089 LAKE BLVD
OCEANSIDE CA
92056-4604
US

IV. Provider business mailing address

4089 LAKE BLVD
OCEANSIDE CA
92056-4604
US

V. Phone/Fax

Practice location:
  • Phone: 413-575-2892
  • Fax:
Mailing address:
  • Phone: 413-575-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: