Provider Demographics
NPI:1700919685
Name:SANTIAGO-VENTURE, CHERYL JUDEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:JUDEE
Last Name:SANTIAGO-VENTURE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:JUDEE
Other - Last Name:KATNIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:24050 MADISON ST. SUITE 108
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-387-8201
Mailing Address - Fax:310-373-9272
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-387-8201
Practice Address - Fax:310-373-9272
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X103T00000X
CAPSY21801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist