Provider Demographics
NPI:1962857904
Name:MARANAN, DANDEL JASON GAVIOLA
Entity Type:Individual
Prefix:
First Name:DANDEL JASON
Middle Name:GAVIOLA
Last Name:MARANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 DONNER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6096
Mailing Address - Country:US
Mailing Address - Phone:727-742-2005
Mailing Address - Fax:
Practice Address - Street 1:2971 DONNER AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6096
Practice Address - Country:US
Practice Address - Phone:727-742-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 10745225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant