Provider Demographics
NPI:1801045042
Name:SANTAMARIA, MILAGRO E
Entity Type:Individual
Prefix:MRS
First Name:MILAGRO
Middle Name:E
Last Name:SANTAMARIA
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 1:513 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2087
Mailing Address - Country:US
Mailing Address - Phone:323-369-8393
Mailing Address - Fax:
Practice Address - Street 1:11001 VALLEY MALL
Practice Address - Street 2:SUITE 300
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2620
Practice Address - Country:US
Practice Address - Phone:626-442-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN832OtherLA COUNTY DMH