Provider Demographics
NPI:1700939964
Name:DABATOS, NATHANIEL PICARDAL (PT)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:PICARDAL
Last Name:DABATOS
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 1:27266 VALDERRAMA DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91381-0677
Mailing Address - Country:US
Mailing Address - Phone:661-253-8961
Mailing Address - Fax:661-253-8351
Practice Address - Street 1:23845 MCBEAN PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2001
Practice Address - Country:US
Practice Address - Phone:661-253-8959
Practice Address - Fax:661-253-8351
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC5427913OtherDRIVER'S LICENSE