Active NPI
Jay De Leon Carizon, PTA
- Physical Therapy Assistant
- Costa Mesa, CA
National Provider Identifier
1295266500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 48626
- Practice address
- 2675 Irvine Ave
#116
Costa Mesa, CA 92627-4653 - Phone
- (949) 631-0200
- NPI assigned
- Mar 27, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 48626 | CA | Primary |
Addresses
Primary practice location
2675 Irvine Ave
#116
Costa Mesa, CA 92627-4653
Mailing address
429 E 1St St
Tustin, CA 92780-3311
Phone (760) 408-3993
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48626 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490572800000",
"number": "1295266500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 E 1ST ST",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803311",
"telephone_number": "760-408-3993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2675 IRVINE AVE",
"address_2": "#116",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926274653",
"telephone_number": "949-631-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LEON CARIZON",
"first_name": "JAY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-27",
"last_updated": "2017-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "48626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.