Healthcare Provider Details

I. General information

NPI: 1548027907
Provider Name (Legal Business Name): SOPHIA HELENA SANTAMARIA L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 EMERY DR
WAUSAU WI
54401-9710
US

IV. Provider business mailing address

1909 N 2ND ST
WAUSAU WI
54403-3411
US

V. Phone/Fax

Practice location:
  • Phone: 715-675-6771
  • Fax:
Mailing address:
  • Phone: 310-866-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20017
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: