Provider Demographics
NPI:1629573696
Name:LISTON, DORION (PHD)
Entity Type:Individual
Prefix:
First Name:DORION
Middle Name:
Last Name:LISTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 W EL CAMINO REAL STE E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2489
Mailing Address - Country:US
Mailing Address - Phone:415-992-1745
Mailing Address - Fax:
Practice Address - Street 1:1398 W EL CAMINO REAL STE E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2489
Practice Address - Country:US
Practice Address - Phone:415-992-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment