MEDICARE: MS. CRISANTA REDUBLO SANTOS R.N.

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	445298	CA

General Provider Information

NPI Number	:	1326123217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRISANTA REDUBLO SANTOS R.N.

Provider Business Mailing Address
First Line	:	100 W 1ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-4112
Country	:	US
Telephone Number	:	213-305-2975
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W 1ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-4112
Country	:	US
Telephone Number	:	213-305-2975
Fax Number	:

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	03/17/2014

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