Provider Demographics
NPI:1457482028
Name:SANTILLAN, ERNESTO JR (ASW)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:SANTILLAN
Suffix:JR
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S. L STREET
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-3205
Mailing Address - Country:US
Mailing Address - Phone:559-591-6680
Mailing Address - Fax:
Practice Address - Street 1:144 S. L STREET
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618
Practice Address - Country:US
Practice Address - Phone:559-591-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical