Provider Demographics
NPI:1508456781
Name:CARRANZA-PENA, DEEDEE
Entity Type:Individual
Prefix:
First Name:DEEDEE
Middle Name:
Last Name:CARRANZA-PENA
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 1:1563 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2543
Mailing Address - Country:US
Mailing Address - Phone:415-762-3700
Mailing Address - Fax:
Practice Address - Street 1:1735 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2417
Practice Address - Country:US
Practice Address - Phone:415-762-3700
Practice Address - Fax:415-865-0119
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA10049101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty