Provider Demographics
NPI:1972789766
Name:SANTILLI, LAUREN CAROL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CAROL
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:CAROL
Other - Last Name:CUEVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25455 BARTON RD
Mailing Address - Street 2:SUITE A 108
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3128
Mailing Address - Country:US
Mailing Address - Phone:909-558-6304
Mailing Address - Fax:909-558-6206
Practice Address - Street 1:25455 BARTON RD
Practice Address - Street 2:SUITE A 108
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3128
Practice Address - Country:US
Practice Address - Phone:909-558-6304
Practice Address - Fax:909-558-6206
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant