Provider Demographics
NPI:1215738158
Name:DIMZON, REINALD CHRIS (COTA/L)
Entity type:Individual
Prefix:
First Name:REINALD
Middle Name:CHRIS
Last Name:DIMZON
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 LAVENDER CT
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-3716
Mailing Address - Country:US
Mailing Address - Phone:951-306-9776
Mailing Address - Fax:
Practice Address - Street 1:2176 LAVENDER CT
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3716
Practice Address - Country:US
Practice Address - Phone:951-306-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6131224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant