Provider Demographics
NPI:1851600373
Name:DIZON, ANALYN SAN PEDRO (OD)
Entity Type:Individual
Prefix:
First Name:ANALYN
Middle Name:SAN PEDRO
Last Name:DIZON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANALYN
Other - Middle Name:MANUMBAS
Other - Last Name:SAN PEDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 S BARKER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1473
Mailing Address - Country:US
Mailing Address - Phone:510-501-4414
Mailing Address - Fax:
Practice Address - Street 1:2580 OLD 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-2055
Practice Address - Country:US
Practice Address - Phone:925-449-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13546TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist