Provider Demographics
NPI:1639363112
Name:DAVE, HITEN Y (RPT)
Entity Type:Individual
Prefix:MR
First Name:HITEN
Middle Name:Y
Last Name:DAVE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 SANTA RITA RD
Mailing Address - Street 2:A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8304
Mailing Address - Country:US
Mailing Address - Phone:925-426-6986
Mailing Address - Fax:925-426-0277
Practice Address - Street 1:3120 SANTA RITA RD
Practice Address - Street 2:A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8304
Practice Address - Country:US
Practice Address - Phone:925-426-6986
Practice Address - Fax:925-426-0277
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT129312Medicare PIN