Provider Demographics
NPI:1346133030
Name:SAN JUAN, MARY ANN ALLORDA
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:ALLORDA
Last Name:SAN JUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 HIGGINS AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3042
Mailing Address - Country:US
Mailing Address - Phone:510-499-3075
Mailing Address - Fax:
Practice Address - Street 1:1749 HIGGINS AVE APT 2
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3042
Practice Address - Country:US
Practice Address - Phone:510-499-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant