Provider Demographics
NPI:1972534535
Name:SANTILLI, GINA R (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:R
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5687 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1129
Mailing Address - Country:US
Mailing Address - Phone:562-866-8384
Mailing Address - Fax:562-920-1454
Practice Address - Street 1:11428 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6611
Practice Address - Country:US
Practice Address - Phone:562-866-8384
Practice Address - Fax:562-920-1454
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24212111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician