Provider Demographics
NPI:1417419920
Name:SANTIAGO GONZALEZ, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANTIAGO GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15196 JOANNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1232
Mailing Address - Country:US
Mailing Address - Phone:408-531-7398
Mailing Address - Fax:
Practice Address - Street 1:1171 HOMESTEAD RD STE 250
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5485
Practice Address - Country:US
Practice Address - Phone:408-320-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician