Healthcare Provider Details

I. General information

NPI: 1063542801
Provider Name (Legal Business Name): MR. MIGUEL SANTUARIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/11/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DRIVE
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

2322 GLENDALE CIR
ANTIOCH CA
94509-5860
US

V. Phone/Fax

Practice location:
  • Phone: 510-317-1437
  • Fax: 510-276-6828
Mailing address:
  • Phone: 415-595-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1063542801
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number1063542801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: