Provider Demographics
NPI:1356425540
Name:HIZON, JOSEFINA L (MD)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:L
Last Name:HIZON
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 1:2700 CORAL RIDGE AVENUE
Mailing Address - Street 2:IMCC
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-626-2391
Mailing Address - Fax:319-665-6721
Practice Address - Street 1:2700 CORAL RIDGE AVENUE
Practice Address - Street 2:IOWA MEDICAL AND CLASSIFICATION CENTER
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-626-2391
Practice Address - Fax:319-665-6721
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA185172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30617OtherMEDICARE GROUP PTAN
IAI16520OtherMEDICARE PTAN
IAI18598Medicare PIN
IA30617OtherMEDICARE GROUP PTAN