Individual
AMBROSIA SANTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
42404 LEEDS FIELD DR, CHANTILLY, VA 20152-5966
(571) 438-9590
Mailing address
42404 LEEDS FIELD DR, CHANTILLY, VA 20152-5966
(571) 438-9590
Taxonomy
Speciality
Code
Description
License number
State
156FX1101X
Ophthalmic Assistant
—
—
363A00000X
Physician Assistant
Primary
0110-007505
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/27/2015
Last updated
10/01/2020
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