Healthcare Provider Details

I. General information

NPI: 1578723821
Provider Name (Legal Business Name): JEAMIELYN SANTIAGO LAXAMANA PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 DALE CT
VACAVILLE CA
95688-9472
US

IV. Provider business mailing address

342 DALE CT
VACAVILLE CA
95688-9472
US

V. Phone/Fax

Practice location:
  • Phone: 707-685-6078
  • Fax: 707-469-1300
Mailing address:
  • Phone: 707-685-6078
  • Fax: 707-469-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: