Provider Demographics
NPI:1033583380
Name:SANTOS, ELIZABETH SALDANA (MFT- INTERN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SALDANA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MFT- INTERN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SALDANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT- INTERN
Mailing Address - Street 1:27410 MANGANESE RD
Mailing Address - Street 2:
Mailing Address - City:QUAIL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 TECHNOLOGY CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2155
Practice Address - Country:US
Practice Address - Phone:951-581-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF70977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist