Provider Demographics
NPI:1396524567
Name:CARIZON, MARIZ JANE BACASMO (FNP)
Entity type:Individual
Prefix:
First Name:MARIZ JANE
Middle Name:BACASMO
Last Name:CARIZON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2412
Mailing Address - Country:US
Mailing Address - Phone:760-464-6025
Mailing Address - Fax:
Practice Address - Street 1:363 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2412
Practice Address - Country:US
Practice Address - Phone:760-464-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA839010163W00000X
CA95027416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse