MEDICARE: KARINA G SANTIBANEZ NPP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401621-1	NY

General Provider Information

NPI Number	:	1649602491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA G SANTIBANEZ NPP

Provider Business Mailing Address
First Line	:	3151 STONY ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1913
Country	:	US
Telephone Number	:	914-885-1995
Fax Number	:	718-583-6358

Provider Business Practice Location Address
First Line	:	3151 STONY ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1913
Country	:	US
Telephone Number	:	914-885-1995
Fax Number	:	718-583-6358

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

Provider Enumeration Date	:	08/04/2013
Last Update Date	:	08/19/2022

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