Provider Demographics
NPI:1033794334
Name:SANTANA, CHARMAINE DIANE (AMFT)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:DIANE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 N TAMARIND AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3657
Mailing Address - Country:US
Mailing Address - Phone:407-452-9429
Mailing Address - Fax:
Practice Address - Street 1:3259 N TAMARIND AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-3657
Practice Address - Country:US
Practice Address - Phone:407-452-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist