Healthcare Provider Details

I. General information

NPI: 1104087576
Provider Name (Legal Business Name): WENDY SANTOS-MODESITT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EMBARCADERO W STE 145
OAKLAND CA
94607-4500
US

IV. Provider business mailing address

11 EMBARCADERO W STE 145
OAKLAND CA
94607-4500
US

V. Phone/Fax

Practice location:
  • Phone: 415-203-7637
  • Fax:
Mailing address:
  • Phone: 415-203-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY27242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: