Healthcare Provider Details

I. General information

NPI: 1295359412
Provider Name (Legal Business Name): ALICIA LOUISE DE SANTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA LOUISE BEGAN

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 BALBOA AVE
SAN DIEGO CA
92111-3447
US

IV. Provider business mailing address

4682 NARRAGANSETT AVE
SAN DIEGO CA
92107-2902
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-8232
  • Fax: 858-496-8234
Mailing address:
  • Phone: 805-443-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95085188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: