Provider Demographics
NPI:1295863645
Name:AZON INC
Entity Type:Organization
Organization Name:AZON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:909-636-8394
Mailing Address - Street 1:2661 OLYMPIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1306
Mailing Address - Country:US
Mailing Address - Phone:909-636-8394
Mailing Address - Fax:909-590-3989
Practice Address - Street 1:990 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3252
Practice Address - Country:US
Practice Address - Phone:626-577-0215
Practice Address - Fax:626-577-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19687OtherGROUP ID UNDER MEDICARE