Provider Demographics
NPI:1477834687
Name:HRISTOVA, DANIELA STOIMENOVA (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:STOIMENOVA
Last Name:HRISTOVA
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 1:9441 SHADWELL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7213
Mailing Address - Country:US
Mailing Address - Phone:714-930-5878
Mailing Address - Fax:888-257-1807
Practice Address - Street 1:9441 SHADWELL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7213
Practice Address - Country:US
Practice Address - Phone:714-930-5878
Practice Address - Fax:888-257-1807
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4310225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant