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Provider Information for 1720524168


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BRIANNA DESANTIAGO LMFT


Sex: Female

NPI: 1720524168
Last Updated: 2024-02-01
Certification Date: 2024-02-01

Details

NameValue
NPI1720524168
Enumeration Date2017-01-09
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 15643 SOUTHWIND AVE
FONTANA, CA 92336-4158
United States

Phone: 909-904-1256 | Fax:
 
Primary Practice Address 19322 JESSE LN STE 200
RIVERSIDE, CA 92508-5072
United States

Phone: 951-387-4040 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist CA140235