Jessica Lara De Santiago, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

16465 Sierra Lakes Pkwy Ste 140
Fontana, CA 92336-1242

Phone

(909) 244-9593

Fax

(833) 903-0337

NPI assigned

Sep 20, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Anthony Benigno, PSYD., Psychological Services, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fontana, CA
  • NPI 1295202943
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1750717880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1388",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917090047",
            "telephone_number": "909-573-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PKWY STE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361242",
            "telephone_number": "909-244-9593",
            "fax_number": "833-903-0337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Motor Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900343710",
            "country_code": "US",
            "telephone_number": "310-836-1223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE SANTIAGO",
        "first_name": "JESSICA",
        "middle_name": "LARA",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-20",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Editha Q. De Leon, MD
• Isabella Francesca De Leon, CRNA
• Leezeth Perez De Los Reyes
• Dania Michelle De Ramon
• Teresa Lynn De Roulet, MD
• Flavia Mytilineos De Souza
• Aline J De Vera, PHARM.D.
• Arif Dean, P.T.
• Davon Dean
• Alma Rosa Deaquino

• Psychologist in Fontana, CA
• Providers in Fontana, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.