Healthcare Provider Details

I. General information

NPI: 1760202964
Provider Name (Legal Business Name): JOSE CARLOS SANTOS ADTSIII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 210
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 210
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-761-9467
  • Fax:
Mailing address:
  • Phone: 805-761-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: