Provider Demographics
NPI:1619407749
Name:SANTAACRUZ, YISEL
Entity Type:Individual
Prefix:
First Name:YISEL
Middle Name:
Last Name:SANTAACRUZ
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 1:6833 STOCKTON BLVD STE 485
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2376
Mailing Address - Country:US
Mailing Address - Phone:916-394-0800
Mailing Address - Fax:916-429-7824
Practice Address - Street 1:6833 STOCKTON BLVD STE 485
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2376
Practice Address - Country:US
Practice Address - Phone:916-394-0800
Practice Address - Fax:916-429-7824
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78918104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker