Healthcare Provider Details

I. General information

NPI: 1265150262
Provider Name (Legal Business Name): ALYSSA DE LOS SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

IV. Provider business mailing address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax: 714-824-8142
Mailing address:
  • Phone: 714-824-8140
  • Fax: 714-824-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW131826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: