Provider Demographics
NPI:1134260151
Name:SANTIAGO, JEANETTE DONES (PT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:DONES
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SHELL BLVD
Mailing Address - Street 2:#6
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2947
Mailing Address - Country:US
Mailing Address - Phone:650-299-4049
Mailing Address - Fax:650-299-3566
Practice Address - Street 1:1150 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2037
Practice Address - Country:US
Practice Address - Phone:650-299-4049
Practice Address - Fax:650-299-3566
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW807546OtherUSERNAME