Provider Demographics
NPI:1306618574
Name:SANTIAGO, ULPIANA SHEMANE ANASCO (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ULPIANA SHEMANE
Middle Name:ANASCO
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17635 CLYMER ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6020
Mailing Address - Country:US
Mailing Address - Phone:213-249-0758
Mailing Address - Fax:
Practice Address - Street 1:17635 CLYMER ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6020
Practice Address - Country:US
Practice Address - Phone:213-249-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026144363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care