Provider Demographics
NPI:1538538103
Name:SANTIZO, ELISA MARIAN (OT)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIAN
Last Name:SANTIZO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 MONTANA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2138
Mailing Address - Country:US
Mailing Address - Phone:424-254-4831
Mailing Address - Fax:
Practice Address - Street 1:6033 W CENTURY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6440
Practice Address - Country:US
Practice Address - Phone:310-215-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist