Provider Demographics
NPI:1255719860
Name:DIZON, MARC JOSEPH BERNAL (RN)
Entity type:Individual
Prefix:MR
First Name:MARC JOSEPH
Middle Name:BERNAL
Last Name:DIZON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500087
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0087
Mailing Address - Country:US
Mailing Address - Phone:670-989-6000
Mailing Address - Fax:
Practice Address - Street 1:6 CHALAN PALE ARNOLD RD
Practice Address - Street 2:GUALO RAI PLAZA
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-233-3647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPR14185163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health