Provider Demographics
NPI:1104503416
Name:SANTA ANA, DIANA ALEJANDRA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ALEJANDRA
Last Name:SANTA ANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 SMOKETREE DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4533
Mailing Address - Country:US
Mailing Address - Phone:760-879-2812
Mailing Address - Fax:
Practice Address - Street 1:260 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2616
Practice Address - Country:US
Practice Address - Phone:760-879-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst