Provider Demographics
NPI:1366709925
Name:DUQUE, SANTOS ROBERT (BS CATC III)
Entity type:Individual
Prefix:
First Name:SANTOS
Middle Name:ROBERT
Last Name:DUQUE
Suffix:
Gender:M
Credentials:BS CATC III
Other - Prefix:
Other - First Name:SANTOS
Other - Middle Name:ROBERT
Other - Last Name:DUQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS CATC III
Mailing Address - Street 1:4441 E CESAR CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3604
Mailing Address - Country:US
Mailing Address - Phone:559-600-9180
Mailing Address - Fax:
Practice Address - Street 1:4441 E CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:559-600-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012652101YA0400X
225400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner