Provider Demographics
NPI:1700368784
Name:SANTOS, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
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 1:11721 TELEGRAPH RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6835
Mailing Address - Country:US
Mailing Address - Phone:562-949-8455
Mailing Address - Fax:562-949-4807
Practice Address - Street 1:11721 TELEGRAPH RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6835
Practice Address - Country:US
Practice Address - Phone:562-949-8455
Practice Address - Fax:562-949-4807
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 171M00000X
CAMPSS-RVAMEO175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator