Provider Demographics
NPI:1588448377
Name:ANA SANTAOLALLA, LICENSED MARRIAGE AND FAMILY THERAPY
Entity type:Organization
Organization Name:ANA SANTAOLALLA, LICENSED MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAOLALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:323-646-6094
Mailing Address - Street 1:1551 COLORADO BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1496
Mailing Address - Country:US
Mailing Address - Phone:323-646-6094
Mailing Address - Fax:
Practice Address - Street 1:1551 COLORADO BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1496
Practice Address - Country:US
Practice Address - Phone:323-646-6094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)