Provider Demographics
NPI:1073823100
Name:SANTOYO, SHELLY TINA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:TINA
Last Name:SANTOYO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHELLY
Other - Middle Name:TINA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3606
Mailing Address - Country:US
Mailing Address - Phone:559-593-2858
Mailing Address - Fax:
Practice Address - Street 1:2570 JENSEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2269
Practice Address - Country:US
Practice Address - Phone:559-875-3428
Practice Address - Fax:559-875-3434
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA21266OtherPHYSICIAN ASSISTANT LICENSE