Basic Information
| Provider Information | |||||||||
| NPI: | 1821544016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTACRUZ | ||||||||
| FirstName: | YVETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12153 SHY ST | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906501869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623567783 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1721 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900313312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232214134 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 72214 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.