Provider Demographics
NPI:1033307103
Name:SANTILLAN, GERARDO BARAJAS (RN,MA,BS)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:BARAJAS
Last Name:SANTILLAN
Suffix:
Gender:M
Credentials:RN,MA,BS
Other - Prefix:MR
Other - First Name:GERARDO
Other - Middle Name:BARAJAS
Other - Last Name:SANTILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,MA,BS
Mailing Address - Street 1:9237 VENTANA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3478
Mailing Address - Country:US
Mailing Address - Phone:818-456-9616
Mailing Address - Fax:
Practice Address - Street 1:9237 VENTANA LN
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-3478
Practice Address - Country:US
Practice Address - Phone:818-456-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA699278163W00000X, 163WC0200X, 163WC0400X, 163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0200XNursing Service ProvidersRegistered NursePediatrics