Provider Demographics
NPI:1245351485
Name:SANTIAGO, AMY BAUTISTA (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BAUTISTA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16323 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5209
Mailing Address - Country:US
Mailing Address - Phone:562-925-7716
Mailing Address - Fax:562-867-0665
Practice Address - Street 1:16323 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5209
Practice Address - Country:US
Practice Address - Phone:562-925-7716
Practice Address - Fax:562-867-0665
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13922363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13922OtherNP FURNISHING
CA544251OtherRN LICENSE