Provider Demographics
NPI:1063839066
Name:QUIWA, CAROLINE GRACE DIZON (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE GRACE
Middle Name:DIZON
Last Name:QUIWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12470 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1017
Mailing Address - Country:US
Mailing Address - Phone:800-823-4040
Mailing Address - Fax:
Practice Address - Street 1:12470 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1017
Practice Address - Country:US
Practice Address - Phone:800-823-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA145959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program