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NPI Code Detail

MEDICARE: ETHAN DIZON

MEDICARE: ETHAN DIZON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerCA

General Provider Information

NPI Number : 1245162460
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN DIZON
Provider Business Mailing Address
First Line : 41550 ECLECTIC ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-1967
Country : US
Telephone Number : 760-299-5181
Fax Number : 877-214-4220
Provider Business Practice Location Address
First Line : 41550 ECLECTIC ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-1967
Country : US
Telephone Number : 760-299-5181
Fax Number : 877-214-4220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ ETHAN DIZON ” Practice Location

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