Healthcare Provider Details

I. General information

NPI: 1700948452
Provider Name (Legal Business Name): DERRON SANTIN M.S., M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 SACRAMENTO ST
SAN FRANCISCO CA
94118-1709
US

IV. Provider business mailing address

3663 SACRAMENTO ST
SAN FRANCISCO CA
94118-1709
US

V. Phone/Fax

Practice location:
  • Phone: 415-255-2673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number46154
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: