Healthcare Provider Details

I. General information

NPI: 1003521196
Provider Name (Legal Business Name): JULIO SANTOS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 10TH ST
SAN FRANCISCO CA
94103-2604
US

IV. Provider business mailing address

115 10TH ST
SAN FRANCISCO CA
94103-2604
US

V. Phone/Fax

Practice location:
  • Phone: 415-734-6553
  • Fax:
Mailing address:
  • Phone: 415-290-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-FKWDXO
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: