Basic Information
| Provider Information | |||||||||
| NPI: | 1083232920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTANA | ||||||||
| FirstName: | AUDRIANA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922202046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095205743 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3924 RIVERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | JURUPA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925096611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513604175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2020 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.