Provider Demographics
NPI:1447409990
Name:DACULA, HANNIVI O (RPT)
Entity Type:Individual
Prefix:
First Name:HANNIVI
Middle Name:O
Last Name:DACULA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:HANNIVI
Other - Middle Name:O
Other - Last Name:DADIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24 HAMMOND
Mailing Address - Street 2:UNIT C
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1680
Mailing Address - Country:US
Mailing Address - Phone:949-770-6022
Mailing Address - Fax:800-924-7223
Practice Address - Street 1:412 W AVENUE J
Practice Address - Street 2:# G
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3685
Practice Address - Country:US
Practice Address - Phone:661-945-0884
Practice Address - Fax:800-924-7223
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist