MEDICARE: MISS EMMA LYN MENDOZA SANTOS PT

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	225100000X	Physical Therapist	62127	OR
2	225100000X	Physical Therapist	26325	MD
3	225100000X	Physical Therapist	PT32271	FL
4	225100000X	Physical Therapist	296109	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W232050101	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1437695400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMMA LYN MENDOZA SANTOS PT

Provider Business Mailing Address
First Line	:	246 HART DR APT 1311
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-4576
Country	:	US
Telephone Number	:	954-939-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 HART DR APT 1311
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-4576
Country	:	US
Telephone Number	:	954-939-1963
Fax Number	:

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

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	03/31/2020

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