Provider Demographics
NPI:1831866516
Name:DE AUSEN SANTOS, GRETCHEN ORDONEZ (MSN, NP-C)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ORDONEZ
Last Name:DE AUSEN SANTOS
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 S MELROSE DR STE 415
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6655
Mailing Address - Country:US
Mailing Address - Phone:626-765-4321
Mailing Address - Fax:
Practice Address - Street 1:380 S MELROSE DR STE 415
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6655
Practice Address - Country:US
Practice Address - Phone:626-765-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018187363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily