Healthcare Provider Details

I. General information

NPI: 1477030534
Provider Name (Legal Business Name): FRANCIS DIZON MS, RD, CSSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 03/25/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 WAREHOUSE ST
ANCHORAGE AK
99505
US

IV. Provider business mailing address

804 WAREHOUSE ST
ANCHORAGE AK
99505
US

V. Phone/Fax

Practice location:
  • Phone: 323-229-7472
  • Fax:
Mailing address:
  • Phone: 323-229-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86063647
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86063647
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: