Provider Demographics
NPI:1336636810
Name:DACANAY, JOEL (LMT,)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DACANAY
Suffix:
Gender:M
Credentials:LMT,
Other - Prefix:MR
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:DACANAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11783 BRANDYWINE PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3915
Mailing Address - Country:US
Mailing Address - Phone:909-569-3913
Mailing Address - Fax:
Practice Address - Street 1:680 LANGSDORF DR STE 100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3702
Practice Address - Country:US
Practice Address - Phone:909-569-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Other$$$$$$$$$
$$$$$$$$$Other$$$$$$$$$