Basic Information
| Provider Information | |||||||||
| NPI: | 1255825196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DACOCO | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | HUTALLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3042 TOSCA WAY | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945201625 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CROW CANYON CT | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885318385 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2018 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.