Provider Demographics
NPI:1497217095
Name:SANTA IGLESIA, JACQUELINE M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:SANTA IGLESIA
Suffix:
Gender:F
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 1:2145 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1141
Mailing Address - Country:US
Mailing Address - Phone:408-606-8201
Mailing Address - Fax:
Practice Address - Street 1:1241 E HILLSDALE BLVD STE 170
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1259
Practice Address - Country:US
Practice Address - Phone:650-571-5185
Practice Address - Fax:650-571-5183
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist