Healthcare Provider Details

I. General information

NPI: 1639219074
Provider Name (Legal Business Name): ANTONIO DIMAANO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 EL CAMINO REAL STE 101
PALO ALTO CA
94306-1706
US

IV. Provider business mailing address

387 SPRING PARK RD
CAMARILLO CA
93012-7734
US

V. Phone/Fax

Practice location:
  • Phone: 650-565-8090
  • Fax: 650-565-8095
Mailing address:
  • Phone: 650-565-8090
  • Fax: 650-565-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: