MEDICARE: DERRON SANTIN M.S., M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	305R00000X	Preferred Provider Organization	46154	CA

General Provider Information

NPI Number	:	1700948452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRON SANTIN M.S., M.F.T.

Provider Business Mailing Address
First Line	:	3663 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1709
Country	:	US
Telephone Number	:	415-255-2673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	12/28/2009

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