Provider Demographics
NPI:1558185348
Name:SALDANA, TRISTAN DESTRY
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:DESTRY
Last Name:SALDANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 WALNUT ST # 291
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1405
Mailing Address - Country:US
Mailing Address - Phone:415-390-5920
Mailing Address - Fax:
Practice Address - Street 1:1442 WALNUT ST # 291
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1405
Practice Address - Country:US
Practice Address - Phone:415-390-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT117367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist