MEDICARE: LARA ELISABETH DESANTO

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	106H00000X	Marriage & Family Therapist	155371	CA

General Provider Information

NPI Number	:	1316894280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA ELISABETH DESANTO

Provider Business Mailing Address
First Line	:	PO BOX 34722
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-0722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 PICO BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1224
Country	:	US
Telephone Number	:	323-574-0558
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ LARA ELISABETH DESANTO ” Practice Location

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