Provider Demographics
NPI:1639219074
Name:DIMAANO, ANTONIO (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:DIMAANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 SPRING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7734
Mailing Address - Country:US
Mailing Address - Phone:650-565-8090
Mailing Address - Fax:650-565-8095
Practice Address - Street 1:2450 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1706
Practice Address - Country:US
Practice Address - Phone:650-565-8090
Practice Address - Fax:650-565-8095
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT29692OtherLICENSE