Provider Demographics
NPI:1982741799
Name:SANTIAGO, CESAR J JR (MA, MFTI 58471)
Entity type:Individual
Prefix:MR
First Name:CESAR
Middle Name:J
Last Name:SANTIAGO
Suffix:JR
Gender:M
Credentials:MA, MFTI 58471
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1132
Mailing Address - Country:US
Mailing Address - Phone:510-317-1437
Mailing Address - Fax:
Practice Address - Street 1:1160 N DUTTON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4600
Practice Address - Country:US
Practice Address - Phone:707-545-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 58471101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor