Provider Demographics
NPI:1992267116
Name:SANTOS VISTAN, MARIA CARISSA FERRER (MD)
Entity type:Individual
Prefix:
First Name:MARIA CARISSA
Middle Name:FERRER
Last Name:SANTOS VISTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA CARISSA
Other - Middle Name:FERRER
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 CASTILE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5667
Mailing Address - Country:US
Mailing Address - Phone:650-296-5508
Mailing Address - Fax:
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5110
Practice Address - Fax:408-885-5117
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program