Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | PT23875 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT23875 | CA |
NPI | 1023146461 |
---|---|
Provider Name | Mr. Allan P. Dizon |
First Address | Chino Hills, CA 91709-1306 |
Second Address | Ontario, CA 91762-6723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 12/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q24373 | (02) | CA |