Provider Demographics
NPI:1982867784
Name:VILLAFUERTE, ANNAVAL DACANAY (PT)
Entity Type:Individual
Prefix:
First Name:ANNAVAL
Middle Name:DACANAY
Last Name:VILLAFUERTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:D
Other - Last Name:VILLAFUERTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9955 DE SOTO AVE
Mailing Address - Street 2:# 24
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4202
Mailing Address - Country:US
Mailing Address - Phone:831-566-4510
Mailing Address - Fax:
Practice Address - Street 1:9955 DE SOTO AVE
Practice Address - Street 2:# 24
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4202
Practice Address - Country:US
Practice Address - Phone:831-566-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist