Healthcare Provider Details

I. General information

NPI: 1891365227
Provider Name (Legal Business Name): SIENNA PAULINA SANTOYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/02/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S L ST
MADERA CA
93637-4650
US

IV. Provider business mailing address

200 S L ST
MADERA CA
93637-4650
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-4663
  • Fax: 559-675-4667
Mailing address:
  • Phone: 559-675-4663
  • Fax: 559-675-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: