Provider Demographics
NPI:1043591852
Name:SANTOS, BRENDA JUDITH
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JUDITH
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 GATEWAY PARK BLVD
Mailing Address - Street 2:APT 344
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2401
Mailing Address - Country:US
Mailing Address - Phone:916-541-1736
Mailing Address - Fax:
Practice Address - Street 1:4451 GATEWAY PARK BLVD
Practice Address - Street 2:APT 344
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2401
Practice Address - Country:US
Practice Address - Phone:916-541-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator