Provider Demographics
NPI:1154810679
Name:SANTANA, LUIS A (PA-C)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:SANTANA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5379 HAMNER AVE UNIT 801
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-1042
Mailing Address - Country:US
Mailing Address - Phone:888-854-1397
Mailing Address - Fax:
Practice Address - Street 1:5379 HAMNER AVE UNIT 801
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-1042
Practice Address - Country:US
Practice Address - Phone:888-854-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical