Provider Demographics
NPI:1932945078
Name:DELOSSANTOS, ISAIAH JAMES
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:JAMES
Last Name:DELOSSANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 ALAMOS AVE
Mailing Address - Street 2:1648 ALAMOS AVE
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611
Mailing Address - Country:US
Mailing Address - Phone:559-326-6916
Mailing Address - Fax:
Practice Address - Street 1:1648 ALAMOS AVE
Practice Address - Street 2:1648 ALAMOS AVE
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-326-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)