Provider Demographics
NPI:1295165033
Name:SAN ANDRES, NATALIE (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SAN ANDRES
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 GROTON WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5423
Mailing Address - Country:US
Mailing Address - Phone:305-979-9836
Mailing Address - Fax:
Practice Address - Street 1:1720 SE HAIG ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2852
Practice Address - Country:US
Practice Address - Phone:305-979-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500666187Medicaid
OR0330363OtherWA L&I
OR0330364OtherWA L&I
OR0330365OtherWA L&I
OR0330363OtherWA L&I
ORR177489Medicare PIN
OR0330365OtherWA L&I
ORR189650Medicare PIN
ORR173094Medicare PIN
ORR189652Medicare PIN