Provider Demographics
NPI:1588963334
Name:DOS SANTOS, ANTONIO LOPES (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:LOPES
Last Name:DOS SANTOS
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6877 WELL WOOD RD
Mailing Address - Street 2:APT 27-A
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4066
Mailing Address - Country:US
Mailing Address - Phone:801-330-9799
Mailing Address - Fax:
Practice Address - Street 1:6877 WELL WOOD RD
Practice Address - Street 2:APT 27-A
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4066
Practice Address - Country:US
Practice Address - Phone:801-330-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor