Provider Demographics
NPI:1689430720
Name:COSMAN DE LOS SANTOS, RILEIGH
Entity Type:Individual
Prefix:
First Name:RILEIGH
Middle Name:
Last Name:COSMAN DE LOS SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RILIEIGH
Other - Middle Name:
Other - Last Name:COSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:169 MASON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4483
Mailing Address - Country:US
Mailing Address - Phone:707-463-3300
Mailing Address - Fax:707-463-3318
Practice Address - Street 1:169 MASON ST STE 300
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4483
Practice Address - Country:US
Practice Address - Phone:707-463-3300
Practice Address - Fax:707-463-3318
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker