Provider Demographics
NPI:1215465489
Name:DIZON, JOHN P
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:DIZON
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 1:25 ALLEN ST SUITE B, MARTINEZ, CA 94553
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:408-364-7052
Mailing Address - Fax:408-364-4190
Practice Address - Street 1:25 ALLEN ST SUITE B, MARTINEZ, CA 94553
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:408-364-7052
Practice Address - Fax:408-364-4190
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner