Organization
KENNETH P DIZON D.O INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH P DIZON DO (CEO/PRESIDENT)
(760) 256-1004
Entity
Organization
Contact information
Practice address
930 W MAIN ST, BARSTOW, CA 92311-2654
(760) 256-1004
(760) 256-1055
Mailing address
930 W MAIN ST, BARSTOW, CA 92311-2654
(760) 256-1004
(760) 256-1055
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
20A15716
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930
PERSONAL
CA
Enumeration date
01/19/2018
Last updated
03/17/2018
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