MEDICARE: MR. ALBERTO JAVIER SANTELLAN M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1073912846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERTO JAVIER SANTELLAN M.A.

Provider Business Mailing Address
First Line	:	114 TOYON AVE
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-4541
Country	:	US
Telephone Number	:	650-438-6195
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 TOYON AVE
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-4541
Country	:	US
Telephone Number	:	650-438-6195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	08/18/2014

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