Healthcare Provider Details

I. General information

NPI: 1104035005
Provider Name (Legal Business Name): GERMAN WALTEROS MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 MISSION ST
SAN FRANCISCO CA
94110-3917
US

IV. Provider business mailing address

186 BONVIEW ST
SAN FRANCISCO CA
94110-5147
US

V. Phone/Fax

Practice location:
  • Phone: 415-229-0500
  • Fax:
Mailing address:
  • Phone: 415-305-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number25212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: