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General NPI Number Information
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NPI Number | 1992320386
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Entity Type | Individual
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Provider Name | GINO DIZON LEGASPI PTA
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Gender | Male
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 751 S BASCOM AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-2604
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Country | US
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Telephone | 408-885-4342
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Fax |
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Provider Business Mailing Address
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Address Line | 2087 WENDOVER LN
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City | SAN JOSE
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State | CA
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Zip | 95121-1465
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Country | US
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Telephone | 510-378-6503
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 10822
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License Number State | CA
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