Healthcare Provider Details

I. General information

NPI: 1720467467
Provider Name (Legal Business Name): LAUREN GRAE SANTIESTEBAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST STE 170
SAN FRANCISCO CA
94158-2335
US

IV. Provider business mailing address

2550 23RD ST BLDG 9
SAN FRANCISCO CA
94110-3504
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-3811
  • Fax:
Mailing address:
  • Phone: 415-206-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA168593
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA168593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: