MEDICARE: ELIZABETH SANTANA MFT

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	MFC 41271	CA

General Provider Information

NPI Number	:	1639252455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SANTANA MFT

Provider Business Mailing Address
First Line	:	4949 COLLWOOD BLVD. # C 8 1/2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115
Country	:	US
Telephone Number	:	619-583-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	3665 KEARNY VILLA RD
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1953
Country	:	US
Telephone Number	:	858-966-5832
Fax Number	:	858-966-6733

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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