Provider Demographics
NPI:1801577663
Name:CEBALLOS SANTILLAN, IRIS SILVIA
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:SILVIA
Last Name:CEBALLOS SANTILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:SILVIA
Other - Last Name:SANTILLAN-ARZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24626 AVENUE 196
Mailing Address - Street 2:
Mailing Address - City:STRATHMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93267-9457
Mailing Address - Country:US
Mailing Address - Phone:559-804-5493
Mailing Address - Fax:
Practice Address - Street 1:140 S C ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-4822
Practice Address - Country:US
Practice Address - Phone:559-216-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator