MEDICARE: TANISHIA NICOLE SANTANA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW99364	CA

General Provider Information

NPI Number	:	1306401880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHIA NICOLE SANTANA LCSW

Provider Business Mailing Address
First Line	:	23121 VERDUGO DR STE 204
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1339
Country	:	US
Telephone Number	:	949-603-6314
Fax Number	:

Provider Business Practice Location Address
First Line	:	23121 VERDUGO DR STE 204
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1339
Country	:	US
Telephone Number	:	949-603-6314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	07/12/2022

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