Healthcare Provider Details

I. General information

NPI: 1184640880
Provider Name (Legal Business Name): DAVE FACIANA DPT, SCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 TIERRA REJADA RD
MOORPARK CA
93021-3779
US

IV. Provider business mailing address

865 PATRIOT DR STE 202
MOORPARK CA
93021-3405
US

V. Phone/Fax

Practice location:
  • Phone: 805-530-3838
  • Fax: 805-530-3832
Mailing address:
  • Phone: 805-530-3838
  • Fax: 805-530-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: