Healthcare Provider Details

I. General information

NPI: 1467125575
Provider Name (Legal Business Name): MR. NICHOLAS ANTHONY SANTILLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD # 2ND
PASADENA CA
91107-3406
US

IV. Provider business mailing address

2550 E FOOTHILL BLVD # 2ND
PASADENA CA
91107-3406
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5230
  • Fax:
Mailing address:
  • Phone: 626-744-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT120706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: