Provider Demographics
NPI:1386706158
Name:SANTANA, MATTHEW GABRIEL (MAC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GABRIEL
Last Name:SANTANA
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 ELIZABETH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3165
Mailing Address - Country:US
Mailing Address - Phone:415-215-6432
Mailing Address - Fax:
Practice Address - Street 1:720 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-2505
Practice Address - Country:US
Practice Address - Phone:415-392-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program