Healthcare Provider Details

I. General information

NPI: 1316029390
Provider Name (Legal Business Name): SANDRA GAN JUSTEN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA SY GAN P.T.

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

IV. Provider business mailing address

17360 BROOKHURST ST ATTN: CREDENTIALING DEPARTMENT
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-9008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 10979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: