Provider Demographics
NPI:1487343208
Name:DACANAY, VIDA ESTEBAN (RN)
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:ESTEBAN
Last Name:DACANAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2324
Mailing Address - Country:US
Mailing Address - Phone:619-964-7665
Mailing Address - Fax:
Practice Address - Street 1:4290 LAYLA WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3835
Practice Address - Country:US
Practice Address - Phone:619-662-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374601097310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility