Provider Demographics
NPI:1851160212
Name:SANTIBANEZ, AMELIA LEAH (RN)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:LEAH
Last Name:SANTIBANEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:LEAH
Other - Last Name:SANTIBANEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 JEFFERSON BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2350
Mailing Address - Country:US
Mailing Address - Phone:916-403-2900
Mailing Address - Fax:
Practice Address - Street 1:500 JEFFERSON BLVD STE 180
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2350
Practice Address - Country:US
Practice Address - Phone:916-403-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse