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NPI Code Detail

MEDICARE: MARIA G DESANTIAGO

MEDICARE: MARIA G DESANTIAGO
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
1101Y00000XCounselorD3159950CA

General Provider Information

NPI Number : 1679740922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA G DESANTIAGO
Provider Business Mailing Address
First Line : 1149 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1149 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-468-2335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2008
Last Update Date : 05/14/2008

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Directions to “ MARIA G DESANTIAGO ” Practice Location

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