Healthcare Provider Details

I. General information

NPI: 1396894739
Provider Name (Legal Business Name): FRANCES SARANDON LIC PSYCH TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCES HERNANDEZ LIC PSYCH TECH

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BONAIR RD PES
GREENBRAE CA
94904
US

IV. Provider business mailing address

237 PICNIC AVE #28
SAN RAFAEL CA
94901
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-6830
  • Fax: 415-507-2672
Mailing address:
  • Phone: 415-455-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT22691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: