Provider Demographics
NPI:1295359412
Name:DE SANTI, ALICIA LOUISE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LOUISE
Last Name:DE SANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LOUISE
Other - Last Name:BEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4682 NARRAGANSETT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2902
Mailing Address - Country:US
Mailing Address - Phone:805-443-7176
Mailing Address - Fax:
Practice Address - Street 1:6991 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3447
Practice Address - Country:US
Practice Address - Phone:858-496-8232
Practice Address - Fax:858-496-8234
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95085188163W00000X
CA95022161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse