Healthcare Provider Details

I. General information

NPI: 1083122022
Provider Name (Legal Business Name): MRS. JORDAN MARIE SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JORDAN MARIE CELAYA

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STOCKTON BLVD STE 103
SACRAMENTO CA
95816-7098
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9040
  • Fax: 916-262-9043
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: