Provider Demographics
NPI:1184129686
Name:SANTILLANEZ, KRISTINA MARIE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:SANTILLANEZ
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 1:7126 SERENITY DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1738
Mailing Address - Country:US
Mailing Address - Phone:916-470-8485
Mailing Address - Fax:
Practice Address - Street 1:7126 SERENITY DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1738
Practice Address - Country:US
Practice Address - Phone:916-470-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)