Healthcare Provider Details

I. General information

NPI: 1316513690
Provider Name (Legal Business Name): PILAR A DIZON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EL CAMINO REAL
PALO ALTO CA
94306-3324
US

IV. Provider business mailing address

111 EMBARCADERO W APT 1306
OAKLAND CA
94607-3792
US

V. Phone/Fax

Practice location:
  • Phone: 650-565-8090
  • Fax:
Mailing address:
  • Phone: 323-229-9763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: