Individual
JONATHAN DIZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 W WATKINS RD, PHOENIX, AZ 85003-2830
(602) 261-6842
Mailing address
15208 HAYFORD ST, LA MIRADA, CA 90638-5303
(714) 726-3742
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/08/2019
Last updated
04/08/2019
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