Provider Demographics
NPI:1942331699
Name:SOZA, RAUL IGNACIO (DRUG COUNSELOR)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:IGNACIO
Last Name:SOZA
Suffix:
Gender:M
Credentials:DRUG COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARTIN
Mailing Address - State:CA
Mailing Address - Zip Code:95046-9504
Mailing Address - Country:US
Mailing Address - Phone:408-683-4053
Mailing Address - Fax:408-683-0697
Practice Address - Street 1:80 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN MARTIN
Practice Address - State:CA
Practice Address - Zip Code:95046-9504
Practice Address - Country:US
Practice Address - Phone:408-683-4053
Practice Address - Fax:408-683-0697
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)