=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689543399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SARAH SANTIAGO ADEVA
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2025
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 N TEXAS ST APT 117
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94533-7325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-208-2655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3001 N TEXAS ST APT 117
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94533-7325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-208-2655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW101355
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------