Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | SO412231133 | CA |
NPI | 1003151531 |
---|---|
Provider Name | Jose Louis Safont |
First Address | Cotati, CA 94931-4198 |
Second Address | Santa Rosa, CA 95401-3537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2012 |
Last Update Date | 10/12/2012 |