Healthcare Provider Details

I. General information

NPI: 1396524567
Provider Name (Legal Business Name): MARIZ JANE BACASMO CARIZON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-346-0642
  • Fax: 760-340-9152
Mailing address:
  • Phone: 760-346-0642
  • Fax: 760-340-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number839010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: