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General NPI Number Information
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NPI Number | 1518621010
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Entity Type | Individual
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Provider Name | DUSTIN VILLANUEVA DANCEL PTA
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Gender | Male
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 8575 KNOTT AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-3850
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Country | US
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Telephone | 714-262-7557
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Fax |
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Provider Business Mailing Address
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Address Line | 7430 CRESCENT AVE APT 201
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City | BUENA PARK
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State | CA
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Zip | 90620-3866
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Country | US
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Telephone | 626-327-0856
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 50207
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License Number State | CA
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