Healthcare Provider Details

I. General information

NPI: 1417790320
Provider Name (Legal Business Name): JOSEF NOAH J DIZON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEF NOAH JOSHUA ESTADILLA DIZON

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

228 W POMONA AVE
MONROVIA CA
91016-4790
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 747-273-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number24131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: