Provider Demographics
NPI:1699759506
Name:SANTOS, ZENAIDA SALAO (PT)
Entity type:Individual
Prefix:
First Name:ZENAIDA
Middle Name:SALAO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9545
Mailing Address - Country:US
Mailing Address - Phone:760-355-4537
Mailing Address - Fax:760-355-4537
Practice Address - Street 1:578 G ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2411
Practice Address - Country:US
Practice Address - Phone:760-344-2157
Practice Address - Fax:760-344-2273
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0101310Medicaid
CAWPT10131BMedicare PIN