Healthcare Provider Details

I. General information

NPI: 1225943079
Provider Name (Legal Business Name): JEDADIAH PUNSALAN SANTOS CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S AKERS ST STE 230
VISALIA CA
93277-8307
US

IV. Provider business mailing address

820 S AKERS ST STE 230
VISALIA CA
93277-8307
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-3957
  • Fax: 559-732-4709
Mailing address:
  • Phone: 559-732-3957
  • Fax: 559-732-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO007248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: