Healthcare Provider Details

I. General information

NPI: 1447981931
Provider Name (Legal Business Name): DEIMZON SY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 TOWN CENTER DR STE 100
RANCHO CUCAMONGA CA
91730-0361
US

IV. Provider business mailing address

6955 SAN BRUNO CT
FONTANA CA
92336-5059
US

V. Phone/Fax

Practice location:
  • Phone: 909-948-1124
  • Fax:
Mailing address:
  • Phone: 909-728-0932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: