MEDICARE: VEENA THERESA SANDEJAS JACILDO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	9932	CA

General Provider Information

NPI Number	:	1053753822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VEENA THERESA SANDEJAS JACILDO PTA

Provider Business Mailing Address
First Line	:	1415 W NORTH ST
Second Line	:	917
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4358
Country	:	US
Telephone Number	:	714-398-4823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 W NORTH ST
Second Line	:	917
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4358
Country	:	US
Telephone Number	:	714-398-4823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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