Healthcare Provider Details

I. General information

NPI: 1104761477
Provider Name (Legal Business Name): JANICE SANTAMARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 GUERNEVILLE RD
SANTA ROSA CA
95401-4030
US

IV. Provider business mailing address

580 ROHNERT PARK EXPY W APT 343
ROHNERT PARK CA
94928-7965
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-4066
  • Fax:
Mailing address:
  • Phone: 707-579-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: