Provider Demographics
NPI:1386111383
Name:SANTIBANEZ, JASON VERNON (CADC-II, ICADC, SAP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:VERNON
Last Name:SANTIBANEZ
Suffix:
Gender:M
Credentials:CADC-II, ICADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 2ND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-4776
Mailing Address - Country:US
Mailing Address - Phone:530-228-5816
Mailing Address - Fax:530-345-5514
Practice Address - Street 1:608 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2118
Practice Address - Country:US
Practice Address - Phone:530-228-2816
Practice Address - Fax:530-345-5514
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043471216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)