Healthcare Provider Details

I. General information

NPI: 1861632739
Provider Name (Legal Business Name): MRS. DENA CHANTE SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10087 TERRA LOMA DR
RANCHO CORDOVA CA
95670-3202
US

IV. Provider business mailing address

10087 TERRA LOMA DR
RANCHO CORDOVA CA
95670-3202
US

V. Phone/Fax

Practice location:
  • Phone: 916-640-5510
  • Fax: 916-451-4018
Mailing address:
  • Phone: 916-640-5510
  • Fax: 916-451-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: