Provider Demographics
NPI:1659512119
Name:DIONISIO, JAMES MEJICA (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MEJICA
Last Name:DIONISIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2886
Mailing Address - Country:US
Mailing Address - Phone:916-629-4725
Mailing Address - Fax:916-880-5606
Practice Address - Street 1:3041 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2886
Practice Address - Country:US
Practice Address - Phone:916-718-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT-20879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT-20879OtherPHYSICAL THERAPY BOARD OF CALIFORNIA