Healthcare Provider Details

I. General information

NPI: 1962448878
Provider Name (Legal Business Name): MANJIRI DAHDUL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16861 ALGONQUIN ST SUITE A
HUNTINGTON BEACH CA
92649-3810
US

IV. Provider business mailing address

16861 ALGONQUIN ST SUITE A
HUNTINGTON BEACH CA
92649-3810
US

V. Phone/Fax

Practice location:
  • Phone: 714-840-8178
  • Fax: 562-596-0627
Mailing address:
  • Phone: 714-840-8178
  • Fax: 562-596-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number28635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: