Provider Demographics
NPI:1851381230
Name:VAN ENK, SIENNE SANTAMARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:SIENNE
Middle Name:SANTAMARIA
Last Name:VAN ENK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26640 WESTERN AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3600
Mailing Address - Country:US
Mailing Address - Phone:310-325-7855
Mailing Address - Fax:310-325-7955
Practice Address - Street 1:26640 WESTERN AVE
Practice Address - Street 2:SUITE R
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3600
Practice Address - Country:US
Practice Address - Phone:310-325-7855
Practice Address - Fax:310-325-7955
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10560T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO105600Medicaid
CAV03904Medicare UPIN
CASDO105600Medicaid