Provider Demographics
NPI:1003151531
Name:SAFONT, JOSE LOUIS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LOUIS
Last Name:SAFONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7946 SCRIVER CT
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-4198
Mailing Address - Country:US
Mailing Address - Phone:707-565-7641
Mailing Address - Fax:
Practice Address - Street 1:1300 CODDINGTOWN CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3537
Practice Address - Country:US
Practice Address - Phone:707-565-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASO412231133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)