Provider Demographics
NPI:1932238904
Name:SANTA MARIA, ROBERT (REHAB SPECIALIST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SANTA MARIA
Suffix:
Gender:M
Credentials:REHAB SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9640 GULLO AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5252
Mailing Address - Country:US
Mailing Address - Phone:818-686-1556
Mailing Address - Fax:
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1391
Practice Address - Country:US
Practice Address - Phone:818-896-1161
Practice Address - Fax:818-896-1462
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid