Provider Demographics
NPI:1255562443
Name:MAR, SIOMARA DE ANDA (MFTI)
Entity type:Individual
Prefix:MRS
First Name:SIOMARA
Middle Name:DE ANDA
Last Name:MAR
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MS
Other - First Name:SIOMARA
Other - Middle Name:
Other - Last Name:DE ANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:2021 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3302
Mailing Address - Country:US
Mailing Address - Phone:925-776-8200
Mailing Address - Fax:
Practice Address - Street 1:2021 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3302
Practice Address - Country:US
Practice Address - Phone:925-776-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist