Basic Information
| Provider Information | |||||||||
| NPI: | 1992106934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTACROSE | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | CAPOUS | ||||||||
| OtherFirstName: | DIANA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 760 WESTWOOD PLZ # A7-361 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900958353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107946159 | ||||||||
| FaxNumber: | 8056814269 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 CAMINO DEL REMEDIO | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056815401 | ||||||||
| FaxNumber: | 8056814269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2014 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.