Provider Demographics
NPI:1376731505
Name:SANTOS, ALFORT BRIONES (MD,RN)
Entity type:Individual
Prefix:DR
First Name:ALFORT
Middle Name:BRIONES
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1261 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5627
Mailing Address - Country:US
Mailing Address - Phone:925-482-5316
Mailing Address - Fax:925-551-4962
Practice Address - Street 1:3687 MT DIABLO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3746
Practice Address - Country:US
Practice Address - Phone:916-854-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105031207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105031OtherSTATE LICENSE