Healthcare Provider Details

I. General information

NPI: 1083581078
Provider Name (Legal Business Name): STEPHANIE DA SILVA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MARKET ST
SAN FRANCISCO CA
94102-3099
US

IV. Provider business mailing address

870 MARKET ST
SAN FRANCISCO CA
94102-3099
US

V. Phone/Fax

Practice location:
  • Phone: 415-966-6318
  • Fax:
Mailing address:
  • Phone: 415-966-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MTVEXR
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: