Healthcare Provider Details

I. General information

NPI: 1033794334
Provider Name (Legal Business Name): CHARMAINE DIANE SANTANA AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W 4TH ST STE 210
SAN BERNARDINO CA
92401-1409
US

IV. Provider business mailing address

570 W 4TH ST STE 210
SAN BERNARDINO CA
92401-1409
US

V. Phone/Fax

Practice location:
  • Phone: 909-834-8877
  • Fax:
Mailing address:
  • Phone: 909-804-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: