Healthcare Provider Details

I. General information

NPI: 1548490626
Provider Name (Legal Business Name): LUCIA VICTORIA SANTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1269
US

IV. Provider business mailing address

2000 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1269
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2931
  • Fax: 650-341-0674
Mailing address:
  • Phone: 650-573-2931
  • Fax: 650-341-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: