Provider Demographics
NPI:1760197180
Name:SANTIS, CLAUDIA RAQUEL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:RAQUEL
Last Name:SANTIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3400 E FLORENCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5835
Mailing Address - Country:US
Mailing Address - Phone:323-589-9384
Mailing Address - Fax:323-589-0358
Practice Address - Street 1:3400 E FLORENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5835
Practice Address - Country:US
Practice Address - Phone:323-589-9384
Practice Address - Fax:323-589-0358
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95019470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner