Provider Demographics
NPI:1073912473
Name:SANTIAGO, JOSEPH CHRISTIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHRISTIAN
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:886 MAGNOLIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3105
Practice Address - Country:US
Practice Address - Phone:951-340-3402
Practice Address - Fax:951-340-3416
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA2433465Medicare PIN
CACA244394Medicare PIN
CACA243467Medicare PIN
CACA243466Medicare PIN
CACA243468Medicare PIN
CACA243464Medicare PIN
CACA243463Medicare PIN