Healthcare Provider Details

I. General information

NPI: 1720814403
Provider Name (Legal Business Name): JENNIFER SANTOS ANAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SAN JACINTO AVE STE 3
PERRIS CA
92571-2833
US

IV. Provider business mailing address

450 E SAN JACINTO AVE STE 3
PERRIS CA
92571-2833
US

V. Phone/Fax

Practice location:
  • Phone: 951-715-5040
  • Fax:
Mailing address:
  • Phone: 951-715-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-UWHAYX
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: