Provider Demographics
NPI:1477310480
Name:SANTANA, MARLINE N
Entity Type:Individual
Prefix:
First Name:MARLINE
Middle Name:N
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 1:6265 SEPULVEDA BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1126
Mailing Address - Country:US
Mailing Address - Phone:818-779-0555
Mailing Address - Fax:818-779-0455
Practice Address - Street 1:6265 SEPULVEDA BLVD STE 9
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1126
Practice Address - Country:US
Practice Address - Phone:818-779-0555
Practice Address - Fax:818-779-0455
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268610164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse