Provider Demographics
NPI:1912165424
Name:SAN AGUSTIN, CRISTINA GERONIMO
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:GERONIMO
Last Name:SAN AGUSTIN
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 1:245 11TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3732
Mailing Address - Country:US
Mailing Address - Phone:415-355-0311
Mailing Address - Fax:
Practice Address - Street 1:245 11TH ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3732
Practice Address - Country:US
Practice Address - Phone:415-355-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 48301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker