Provider Demographics
NPI:1376670521
Name:SANTOS, MOSES (MSW, PPSC, CWA)
Entity type:Individual
Prefix:MR
First Name:MOSES
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MSW, PPSC, CWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 DOOLITTLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4145
Mailing Address - Country:US
Mailing Address - Phone:415-710-3386
Mailing Address - Fax:
Practice Address - Street 1:13630 DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4145
Practice Address - Country:US
Practice Address - Phone:415-710-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116381104100000X
104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker