Provider Demographics
NPI:1649602491
Name:SANTIBANEZ, KARINA G (NPP)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:G
Last Name:SANTIBANEZ
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 STONY ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1913
Mailing Address - Country:US
Mailing Address - Phone:914-885-1995
Mailing Address - Fax:718-583-6358
Practice Address - Street 1:3151 STONY ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1913
Practice Address - Country:US
Practice Address - Phone:914-885-1995
Practice Address - Fax:718-583-6358
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401621-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health