Provider Demographics
NPI:1730667767
Name:HORTALEZA, JAN DAPHNE (PT)
Entity Type:Individual
Prefix:
First Name:JAN DAPHNE
Middle Name:
Last Name:HORTALEZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVE RM 402
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2224
Mailing Address - Country:US
Mailing Address - Phone:650-994-7760
Mailing Address - Fax:650-240-1834
Practice Address - Street 1:1800 SULLIVAN AVE RM 402
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2224
Practice Address - Country:US
Practice Address - Phone:650-994-7760
Practice Address - Fax:650-240-1834
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist