Healthcare Provider Details

I. General information

NPI: 1639477201
Provider Name (Legal Business Name): JENNIFER LYNN LONTOC ESCOBAR P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER LYNN LONTOC

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N. JACKSON AVE.
SAN JOSE CA
95116
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE. 100
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-8700
  • Fax: 408-259-2343
Mailing address:
  • Phone: 971-206-5200
  • Fax: 971-206-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: