Provider Demographics
NPI:1356858567
Name:SANTANA, YOLANDA (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-7638
Mailing Address - Country:US
Mailing Address - Phone:760-713-7821
Mailing Address - Fax:
Practice Address - Street 1:3920 GRAND AVE STE E
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5484
Practice Address - Country:US
Practice Address - Phone:909-248-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8166332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment