Provider Demographics
NPI:1245235738
Name:SANTIESTEBAN, HECTOR LUIS (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:LUIS
Last Name:SANTIESTEBAN
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:RM 101
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2227
Mailing Address - Country:US
Mailing Address - Phone:650-994-0459
Mailing Address - Fax:650-994-1450
Practice Address - Street 1:1199 BUSH ST 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5975
Practice Address - Country:US
Practice Address - Phone:415-921-8210
Practice Address - Fax:415-921-0387
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60085261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53546Medicare UPIN
CA00G600850Medicare ID - Type Unspecified