Provider Demographics
NPI:1851051064
Name:SANTOS-WILSON, MARIA LISA VITUG
Entity Type:Individual
Prefix:
First Name:MARIA LISA
Middle Name:VITUG
Last Name:SANTOS-WILSON
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 1:7320 DEERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2729
Mailing Address - Country:US
Mailing Address - Phone:510-772-3232
Mailing Address - Fax:
Practice Address - Street 1:7320 DEERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2729
Practice Address - Country:US
Practice Address - Phone:510-772-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other