Provider Demographics
NPI:1043385362
Name:SANTOS, DEIRDRE MCDERMOTT (FNP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MCDERMOTT
Last Name:SANTOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:A
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3172 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4135
Mailing Address - Country:US
Mailing Address - Phone:415-643-1943
Mailing Address - Fax:
Practice Address - Street 1:25 VAN NESS AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6033
Practice Address - Country:US
Practice Address - Phone:415-554-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ15733Medicare UPIN