Provider Demographics
NPI:1184640880
Name:FACIANA, DAVE (DPT, SCS, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:FACIANA
Suffix:
Gender:M
Credentials:DPT, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 PATRIOT DR
Mailing Address - Street 2:STE 202
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3405
Mailing Address - Country:US
Mailing Address - Phone:805-530-3838
Mailing Address - Fax:805-530-3832
Practice Address - Street 1:4225 TIERRA REJADA RD
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3779
Practice Address - Country:US
Practice Address - Phone:805-530-3838
Practice Address - Fax:805-530-3832
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT19246AMedicare UPIN