Provider Demographics
NPI:1508145277
Name:OSORIO, SANTIAGO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:
Last Name:OSORIO
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 1:2424 VISTA WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6178
Mailing Address - Country:US
Mailing Address - Phone:551-574-7459
Mailing Address - Fax:
Practice Address - Street 1:2424 VISTA WAY STE 120
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6178
Practice Address - Country:US
Practice Address - Phone:551-574-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01408500225100000X
CA42536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000OtherMEDICATE