Provider Demographics
NPI:1124421292
Name:SANTAMARIA, JACQUELINE AMARIS
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:AMARIS
Last Name:SANTAMARIA
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 1:652 SUNRISE LAKE PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0955
Mailing Address - Country:US
Mailing Address - Phone:702-279-7745
Mailing Address - Fax:
Practice Address - Street 1:652 SUNRISE LAKE PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-0955
Practice Address - Country:US
Practice Address - Phone:702-279-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVP55 01745103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst