Provider Demographics
NPI:1497142434
Name:SANTIAGO-NEDERVELD, CATANIA DEL CONSUELO (A043111116)
Entity Type:Individual
Prefix:
First Name:CATANIA
Middle Name:DEL CONSUELO
Last Name:SANTIAGO-NEDERVELD
Suffix:
Gender:F
Credentials:A043111116
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2132
Mailing Address - Country:US
Mailing Address - Phone:408-998-5191
Mailing Address - Fax:408-279-2841
Practice Address - Street 1:1340 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4189
Practice Address - Country:US
Practice Address - Phone:925-655-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker