Healthcare Provider Details

I. General information

NPI: 1073823100
Provider Name (Legal Business Name): SHELLY TINA SANTOYO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SHELLY TINA GARCIA

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 JENSEN AVE SUITE 106
SANGER CA
93657-2269
US

IV. Provider business mailing address

2215 CHERRY AVE
SANGER CA
93657-3606
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-3428
  • Fax: 559-875-3434
Mailing address:
  • Phone: 559-593-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: