Healthcare Provider Details

I. General information

NPI: 1336384973
Provider Name (Legal Business Name): MELISA E SANTACROCE SLPA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL SUITE 211-A
SANTA FE NM
87505-1834
US

IV. Provider business mailing address

21600 OXNARD ST SUITE 1800
WOODLAND HILLS CA
91367-4976
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-2345
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax: 818-449-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4470
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-17063
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: