Healthcare Provider Details

I. General information

NPI: 1932945078
Provider Name (Legal Business Name): ISAIAH JAMES DELOSSANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 ALAMOS AVE 1648 ALAMOS AVE
CLOVIS CA
93611
US

IV. Provider business mailing address

1648 ALAMOS AVE 1648 ALAMOS AVE
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-6916
  • Fax:
Mailing address:
  • Phone: 559-326-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: