Provider Demographics
NPI:1063542801
Name:SANTUARIO, MIGUEL
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:SANTUARIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 GLENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5860
Mailing Address - Country:US
Mailing Address - Phone:415-595-6067
Mailing Address - Fax:
Practice Address - Street 1:2275 ARLINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-317-1437
Practice Address - Fax:510-276-6828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA1063542801171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker