Provider Demographics
NPI:1265092274
Name:DIZON, PATRINA ANNE MARIE MARTIN (RDN)
Entity type:Individual
Prefix:
First Name:PATRINA ANNE MARIE
Middle Name:MARTIN
Last Name:DIZON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22536 LOS TIGRES DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2336
Mailing Address - Country:US
Mailing Address - Phone:323-401-4523
Mailing Address - Fax:
Practice Address - Street 1:22536 LOS TIGRES DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2336
Practice Address - Country:US
Practice Address - Phone:323-401-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA963590133V00000X
963590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered