Provider Demographics
NPI:1801441407
Name:SANTANA, ELIDA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ELIDA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3306
Mailing Address - Country:US
Mailing Address - Phone:619-368-3151
Mailing Address - Fax:
Practice Address - Street 1:502 EUCLID AVE STE 304
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-8900
Practice Address - Country:US
Practice Address - Phone:619-477-0084
Practice Address - Fax:619-477-2066
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-12407207QG0300X
CA95012407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine