Healthcare Provider Details

I. General information

NPI: 1730772021
Provider Name (Legal Business Name): EFRAIN SANTAMARIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 SMITH RANCH RD
SAN RAFAEL CA
94903-2093
US

IV. Provider business mailing address

1265 HENDERSON LN
HAYWARD CA
94544-3701
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-0818
  • Fax:
Mailing address:
  • Phone: 628-888-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: