Provider Demographics
NPI:1487087102
Name:SANTIAGO, JENNYZEN C (MPT)
Entity type:Individual
Prefix:MISS
First Name:JENNYZEN
Middle Name:C
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:STE C316
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1883
Mailing Address - Country:US
Mailing Address - Phone:559-916-3070
Mailing Address - Fax:
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:949-722-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist