Healthcare Provider Details

I. General information

NPI: 1851557946
Provider Name (Legal Business Name): JOSIE CINCO DIZON-BAQUIRAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 RIDGESIDE DR
MONROVIA CA
91016-1722
US

IV. Provider business mailing address

788 RIDGESIDE DR
MONROVIA CA
91016-1722
US

V. Phone/Fax

Practice location:
  • Phone: 818-919-2513
  • Fax:
Mailing address:
  • Phone: 323-259-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: