Individual
MR. GENESISJAMES BASILIO DIZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
200 MERCY CIRCLE, CAMP PENDLETON, CA 92055
(818) 454-1131
Mailing address
162 1ST ST, PORT HUENEME, CA 93043-4316
(818) 454-1131
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/01/2013
Last updated
12/05/2025
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