Provider Demographics
NPI:1467513572
Name:DIZON, PERLA ESPINO (MD)
Entity Type:Individual
Prefix:DR
First Name:PERLA
Middle Name:ESPINO
Last Name:DIZON
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 1:4619 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3028
Mailing Address - Country:US
Mailing Address - Phone:281-424-1260
Mailing Address - Fax:
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3153
Practice Address - Country:US
Practice Address - Phone:281-428-7278
Practice Address - Fax:281-422-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE77698Medicare UPIN