Provider Demographics
NPI:1043615685
Name:DIZON, ANGELINE CHIARA MASULIT (RN)
Entity Type:Individual
Prefix:MS
First Name:ANGELINE CHIARA
Middle Name:MASULIT
Last Name:DIZON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 55TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3344
Mailing Address - Country:US
Mailing Address - Phone:917-288-6519
Mailing Address - Fax:
Practice Address - Street 1:3912 55TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3344
Practice Address - Country:US
Practice Address - Phone:917-288-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7796938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse