Provider Demographics
NPI:1528720117
Name:SANTOS, LUCERITO DANIELA
Entity type:Individual
Prefix:MS
First Name:LUCERITO
Middle Name:DANIELA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 GREEN OAK RD
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7821
Mailing Address - Country:US
Mailing Address - Phone:760-277-4640
Mailing Address - Fax:
Practice Address - Street 1:1237 GREEN OAK RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7821
Practice Address - Country:US
Practice Address - Phone:760-277-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor