Healthcare Provider Details

I. General information

NPI: 1275437592
Provider Name (Legal Business Name): YSLA SANTAMARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FRIEDBERG CHURCH RD
WINSTON SALEM NC
27127-9803
US

IV. Provider business mailing address

1921 GRAYWOOD CT
WINSTON SALEM NC
27127-7361
US

V. Phone/Fax

Practice location:
  • Phone: 336-521-3096
  • Fax:
Mailing address:
  • Phone: 336-521-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2803508
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: