Healthcare Provider Details

I. General information

NPI: 1760184006
Provider Name (Legal Business Name): FAITH MARIE DEIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MARK WEST SPRINGS RD
SANTA ROSA CA
95403-1436
US

IV. Provider business mailing address

601 VAN NESS AVE # E3619
SAN FRANCISCO CA
94102-3200
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-4000
  • Fax:
Mailing address:
  • Phone: 415-531-9047
  • Fax: 415-213-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA210937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: