Individual provider Active NPI

Hannivi O Dacula, RPT

  • Physical Therapist
  • Lancaster, CA
National Provider Identifier
1447409990
Registry record updated Feb 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
39803 Issued in CA
Practice address
412 W Avenue J
# G
Lancaster, CA 93534-3685
Phone
(661) 945-0884
Fax
(800) 924-7223
NPI assigned
Sep 9, 2008
Last updated
Feb 20, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 39803 CA Primary

Addresses

Primary practice location

412 W Avenue J
# G
Lancaster, CA 93534-3685

Mailing address

24 Hammond
Unit C
Irvine, CA 92618-1680
Phone (949) 770-6022

Other names 1

  • Hannivi O Dadivas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130508000297 CA Practitioner - Physical Therapist in Private Practice 2365509627 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

44501 16TH St W
Suite 107
Lancaster, CA 93534-2884
Phone (661) 974-7133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39803CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Current Accepting new patients
California Rehab & Sports Therapy CurrentSince Aug 5, 2024 Accepting new patients
Aria Physical Therapy Center CurrentSince May 6, 2021 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist CurrentSince Aug 5, 2024 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Past Accepting new patients
PT Plus Rehab, Inc Physical Therapist PastSince Jun 1, 2015 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Past Accepting new patients

Locations

505 N Euclid St
Ste 680
Anaheim, CA 92801
Phone (714) 780-0010

471 W Lambert Rd
Ste 106
Brea, CA 92821
Phone (714) 255-8877

415 Carmen Dr
Camarillo, CA 93010
Phone (805) 322-9083

255 E Rincon St
Ste 112
Corona, CA 92879
Phone (951) 523-8509

43979 15th St W
Lancaster, CA 93534
Phone (661) 522-3711

44501 16th St W
Ste 107
Lancaster, CA 93534
Phone (661) 974-7033

2888 Long Beach Blvd
Ste 405
Long Beach, CA 90806
Phone (562) 595-4489

11260 Wilbur Ave
Ste 101
Porter Ranch, CA 91326
Phone (818) 832-5656

19000 Hawthorne Blvd
Ste 300
Torrance, CA 90503
Phone (310) 793-1800

25176 Rye Canyon Rd
Valencia, CA 91355
Phone (661) 288-0300

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361318400000",
    "number": "1447409990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 HAMMOND",
            "address_2": "UNIT C",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926181680",
            "telephone_number": "949-770-6022",
            "fax_number": "800-924-7223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W AVENUE J",
            "address_2": "# G",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343685",
            "telephone_number": "661-945-0884",
            "fax_number": "800-924-7223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACULA",
        "first_name": "HANNIVI",
        "middle_name": "O",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2013-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HANNIVI",
            "last_name": "DADIVAS",
            "middle_name": "O",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.