Basic Information
| Provider Information | |||||||||
| NPI: | 1659709905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | JOSUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 W 179TH ST | ||||||||
| Address2: | APT#33 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100336021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177362837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4001 HIGHWAY 104 | ||||||||
| Address2: | |||||||||
| City: | IONE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092744911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 088690 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.