Provider Demographics
NPI:1073953600
Name:SANTIBANEZ, LUZ A (PA)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:A
Last Name:SANTIBANEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1340
Mailing Address - Country:US
Mailing Address - Phone:310-746-8556
Mailing Address - Fax:
Practice Address - Street 1:4566 FLORENCE AVE STE 1
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-4346
Practice Address - Country:US
Practice Address - Phone:323-771-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22843363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical