Provider Demographics
NPI:1326247198
Name:FAILLACE, MARIA M
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:FAILLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1612
Mailing Address - Country:US
Mailing Address - Phone:415-538-5500
Mailing Address - Fax:415-538-5555
Practice Address - Street 1:679 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1612
Practice Address - Country:US
Practice Address - Phone:415-538-5500
Practice Address - Fax:415-538-5555
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)