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NPI Code Detail

MEDICARE: JEROME CHRISTIAN MOSTAZA SANTOS

MEDICARE: JEROME CHRISTIAN MOSTAZA SANTOS
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
1225200000XPhysical Therapy AssistantA-1724NV

General Provider Information

NPI Number : 1851221212
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME CHRISTIAN MOSTAZA SANTOS
Provider Business Mailing Address
First Line : 386 UMBRIA WAY
Second Line :
City : HENDERSON
State : NV
Zip : 89014-5151
Country : US
Telephone Number : 702-417-1438
Fax Number :
Provider Business Practice Location Address
First Line : 6351 N FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-2300
Country : US
Telephone Number : 702-515-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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Directions to “ JEROME CHRISTIAN MOSTAZA SANTOS ” Practice Location

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