Provider Demographics
NPI:1932734654
Name:LACUNA, ANA DANDESSA
Entity Type:Individual
Prefix:
First Name:ANA DANDESSA
Middle Name:
Last Name:LACUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 SONATA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3489
Mailing Address - Country:US
Mailing Address - Phone:310-598-8419
Mailing Address - Fax:
Practice Address - Street 1:1244 TRAVIS BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4802
Practice Address - Country:US
Practice Address - Phone:707-422-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist