Provider Demographics
NPI:1598998676
Name:SANTOSO, MARIANNE VICTORIA
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:VICTORIA
Last Name:SANTOSO
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 1:1507 21ST ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5220
Mailing Address - Country:US
Mailing Address - Phone:916-247-7072
Mailing Address - Fax:
Practice Address - Street 1:3131 PALMER ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1412
Practice Address - Country:US
Practice Address - Phone:916-921-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator