Healthcare Provider Details

I. General information

NPI: 1619967809
Provider Name (Legal Business Name): LIBRO EUGENIO DIZINNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 406
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

9834 GENESEE AVENUE SUITE 406
SAN DIEGO CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-1010
  • Fax: 858-450-9451
Mailing address:
  • Phone: 858-450-1010
  • Fax: 858-450-9451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC30996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: