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General NPI Number Information
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NPI Number | 1851557946
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Entity Type | Individual
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Provider Name | JOSIE CINCO DIZON RDH
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Gender | Female
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1600 SAN FERNANDO RD
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City | SAN FERNANDO
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State | CA
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Zip | 91340-3115
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Country | US
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Telephone | 818-365-8086
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Fax |
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Provider Business Mailing Address
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Address Line | 1326 BROADWAY
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City | BURBANK
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State | CA
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Zip | 91504-4109
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Country | US
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Telephone | 323-259-0853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 22734
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License Number State | CA
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