Individual
MR. GABRIEL SANTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18152 LULL ST, RESEDA, CA 91335-2048
(510) 314-6423
Mailing address
18152 LULL ST, RESEDA, CA 91335-2048
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
AZ
101YP2500X
Professional Counselor
—
AZ
175T00000X
Peer Specialist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01779778
—
CA
Enumeration date
09/02/2021
Last updated
09/18/2021
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