Provider Demographics
NPI:1225684566
Name:TIZON-DAMIANO, MARITONI (NP)
Entity Type:Individual
Prefix:
First Name:MARITONI
Middle Name:
Last Name:TIZON-DAMIANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 E THOUSAND OAKS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6228
Mailing Address - Country:US
Mailing Address - Phone:805-906-2015
Mailing Address - Fax:805-953-8347
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-6228
Practice Address - Country:US
Practice Address - Phone:805-906-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily