Healthcare Provider Details

I. General information

NPI: 1386133734
Provider Name (Legal Business Name): SANTISIA ALICEL AMBROSINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 KEITH ST
SAN FRANCISCO CA
94124-3231
US

IV. Provider business mailing address

2403 KEITH ST
SAN FRANCISCO CA
94124-3231
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-5500
  • Fax:
Mailing address:
  • Phone: 628-217-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW123539
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: