Healthcare Provider Details

I. General information

NPI: 1760396865
Provider Name (Legal Business Name): YESENIA SANTIAGO MSN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 N FAIR OAKS AVE
PASADENA CA
91103-1858
US

IV. Provider business mailing address

1403 N FAIR OAKS AVE
PASADENA CA
91103-1858
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-0354
  • Fax:
Mailing address:
  • Phone: 626-398-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95040629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: