MEDICARE: JANYA ORFEYEVA 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	48536	CA

General Provider Information

NPI Number	:	1699273094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANYA ORFEYEVA PTA

Provider Business Mailing Address
First Line	:	401 ALMOND RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-7338
Country	:	US
Telephone Number	:	703-338-5902
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E WASHINGTON AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-3843
Country	:	US
Telephone Number	:	714-973-1656
Fax Number	:

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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