Provider Demographics
NPI:1932532488
Name:ALY, DILYANA GANCHEVA (DPT)
Entity Type:Individual
Prefix:
First Name:DILYANA
Middle Name:GANCHEVA
Last Name:ALY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DILYANA
Other - Middle Name:GANCHEVA
Other - Last Name:GUGUSHEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE. 234
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6200
Mailing Address - Country:US
Mailing Address - Phone:951-506-3001
Mailing Address - Fax:951-506-3002
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:951-679-8500
Practice Address - Fax:951-679-8522
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA203987Medicare PIN
CACB258350Medicare PIN
CACA203988Medicare PIN