Provider Demographics
NPI:1942947163
Name:SANTOS, RICKY MICHAEL HEATH (PA)
Entity Type:Individual
Prefix:MR
First Name:RICKY MICHAEL
Middle Name:HEATH
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:112 PLAYER CT APT 1
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1954
Mailing Address - Country:US
Mailing Address - Phone:925-726-5115
Mailing Address - Fax:
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3239
Practice Address - Country:US
Practice Address - Phone:800-607-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant