MEDICARE: CYNTHIA MAE PERAZZO 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	AT6747	CA

General Provider Information

NPI Number	:	1619006194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA MAE PERAZZO PTA

Provider Business Mailing Address
First Line	:	834 QUINCE AVE
Second Line	:	#38
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5258
Country	:	US
Telephone Number	:	408-554-0669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1893 MONTEREY HWY
Second Line	:	#200
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6136
Country	:	US
Telephone Number	:	408-288-3800
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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