Provider Demographics
NPI:1134188618
Name:DIZON, GUADALUPE E (MD)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:E
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 1:1413 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2607
Mailing Address - Country:US
Mailing Address - Phone:718-636-4500
Mailing Address - Fax:718-636-2998
Practice Address - Street 1:1413 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2607
Practice Address - Country:US
Practice Address - Phone:718-636-4500
Practice Address - Fax:718-636-2998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119092207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology