Healthcare Provider Details

I. General information

NPI: 1396224374
Provider Name (Legal Business Name): JOANNA TAPIA B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA SANTILLAN

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 HAVEN AVE STE 100
RANCHO CUCAMONGA CA
91730-5871
US

IV. Provider business mailing address

25910 ACERO STE 160
MISSION VIEJO CA
92691-2777
US

V. Phone/Fax

Practice location:
  • Phone: 909-294-0293
  • Fax:
Mailing address:
  • Phone: 714-966-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: