Provider Demographics
NPI:1053753822
Name:JACILDO, VEENA THERESA SANDEJAS (PTA)
Entity type:Individual
Prefix:
First Name:VEENA THERESA
Middle Name:SANDEJAS
Last Name:JACILDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 W NORTH ST
Mailing Address - Street 2:917
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4358
Mailing Address - Country:US
Mailing Address - Phone:714-398-4823
Mailing Address - Fax:
Practice Address - Street 1:1415 W NORTH ST
Practice Address - Street 2:917
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4358
Practice Address - Country:US
Practice Address - Phone:714-398-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9932225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant