Healthcare Provider Details

I. General information

NPI: 1124618186
Provider Name (Legal Business Name): CRISTHIAM ALFREDO SANTOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

IV. Provider business mailing address

17641 KITTRIDGE ST
VAN NUYS CA
91406-5324
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-0202
  • Fax: 310-547-0202
Mailing address:
  • Phone: 562-392-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: