Provider Demographics
NPI:1932753076
Name:SANTA ROSA, DENISE ALEJANDRA I
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ALEJANDRA
Last Name:SANTA ROSA
Suffix:I
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 1:135 DUNTON LN
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1831
Mailing Address - Country:US
Mailing Address - Phone:805-794-6208
Mailing Address - Fax:
Practice Address - Street 1:135 DUNTON LN
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1831
Practice Address - Country:US
Practice Address - Phone:805-794-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician