Provider Demographics
NPI:1699471441
Name:DUMALAOG, EARL DAVID CRUZ
Entity type:Individual
Prefix:
First Name:EARL DAVID
Middle Name:CRUZ
Last Name:DUMALAOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S KRAEMER BLVD UNIT 203
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6107
Mailing Address - Country:US
Mailing Address - Phone:909-610-0397
Mailing Address - Fax:
Practice Address - Street 1:861 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5157
Practice Address - Country:US
Practice Address - Phone:714-635-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51335225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant