Healthcare Provider Details

I. General information

NPI: 1306420476
Provider Name (Legal Business Name): SANNIEL CAILAO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W LINCOLN AVE STE 100
ANAHEIM CA
92805-2950
US

IV. Provider business mailing address

401 W LINCOLN AVE STE 100
ANAHEIM CA
92805-2950
US

V. Phone/Fax

Practice location:
  • Phone: 714-581-5971
  • Fax: 714-581-5972
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT309855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA49767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: