Provider Demographics
NPI:1124120696
Name:SANTANIELLO, JOHN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:SANTANIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4951
Mailing Address - Country:US
Mailing Address - Phone:909-982-4233
Mailing Address - Fax:909-985-1103
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-982-4233
Practice Address - Fax:909-985-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21403OtherMEDICAL LICENSE
CA1124120696OtherJOHN SANTANIELLO (NPI)
CA1265651608OtherSANTANIELLO ORTHO (NPI)
CAZZZ05630ZOtherMEDICARE GROUP PTAN
CA00G214031Medicare PIN
CAG21403OtherMEDICAL LICENSE