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General NPI Number Information
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NPI Number | 1356159339
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Entity Type | Individual
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Provider Name | CRISTIAN DAVID HACEGABA
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Gender | Male
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 801 S RAYMOND AVE
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City | PASADENA
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State | CA
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Zip | 91105-3223
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Country | US
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Telephone | 626-356-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 1086 W CALLE DE LAS ESTRELLAS APT 2
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City | AZUSA
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State | CA
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Zip | 91702-1722
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Country | US
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Telephone | 626-533-2410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 307396
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License Number State | CA
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