Active NPI
Derrick J Dizon
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1902654544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 305377
- Practice address
- 619 N Fairfax Ave
Los Angeles, CA 90036-1714 - Phone
- (323) 651-0043
- NPI assigned
- May 8, 2024
- 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 Therapist | 225100000X | 305377 | CA | Primary |
Addresses
Primary practice location
619 N Fairfax Ave
Los Angeles, CA 90036-1714
Mailing address
10938 Santa Clara CT
Rancho Cucamonga, CA 91701-4432
Phone (626) 824-2985
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 |
|---|---|---|---|
| 305377 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715126400000",
"number": "1902654544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10938 SANTA CLARA CT",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917014432",
"telephone_number": "626-824-2985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 N FAIRFAX AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900361714",
"telephone_number": "323-651-0043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIZON",
"first_name": "DERRICK",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-08",
"last_updated": "2024-05-08",
"certification_date": "2024-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "305377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.