Healthcare Provider Details

I. General information

NPI: 1508524117
Provider Name (Legal Business Name): GINA SANTILLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 404
ORANGE CA
92868-3504
US

IV. Provider business mailing address

PO BOX 2643
ANAHEIM CA
92814-0643
US

V. Phone/Fax

Practice location:
  • Phone: 714-645-8045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: