Provider Demographics
NPI:1225390339
Name:DIZONRVT, CHRIS JERRICSON (RDCS, RVT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:JERRICSON
Last Name:DIZONRVT
Suffix:
Gender:M
Credentials:RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-098 MANAWA PL BLDG O-106
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4072
Mailing Address - Country:US
Mailing Address - Phone:808-330-3025
Mailing Address - Fax:888-782-1408
Practice Address - Street 1:2228 LILIHA ST STE 405
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1654
Practice Address - Country:US
Practice Address - Phone:808-330-3025
Practice Address - Fax:888-782-1408
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI145201246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography