Healthcare Provider Details

I. General information

NPI: 1548073331
Provider Name (Legal Business Name): THOMAS DIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ILENE ST
MARTINEZ CA
94553-2631
US

IV. Provider business mailing address

2568 PINKERTON LN
FAIRFIELD CA
94533-8900
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-7080
  • Fax:
Mailing address:
  • Phone: 858-222-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: