Provider Demographics
NPI:1215359104
Name:SANTANA, ALIZANDRA
Entity Type:Individual
Prefix:
First Name:ALIZANDRA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 104TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2813
Mailing Address - Country:US
Mailing Address - Phone:718-806-1562
Mailing Address - Fax:718-806-1562
Practice Address - Street 1:7260 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2108
Practice Address - Country:US
Practice Address - Phone:718-894-8400
Practice Address - Fax:718-894-8410
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool