Healthcare Provider Details

I. General information

NPI: 1508100769
Provider Name (Legal Business Name): ASUNCION PURISIMA DISINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2012
Last Update Date: 11/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 WOODVIEW PL
SAN JOSE CA
95120-3233
US

IV. Provider business mailing address

1057 WOODVIEW PL
SAN JOSE CA
95120-3233
US

V. Phone/Fax

Practice location:
  • Phone: 408-268-8027
  • Fax:
Mailing address:
  • Phone: 408-268-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC39875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: