Healthcare Provider Details

I. General information

NPI: 1356425540
Provider Name (Legal Business Name): JOSEFINA L HIZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CORAL RIDGE AVENUE IOWA MEDICAL AND CLASSIFICATION CENTER
CORALVILLE IA
52241
US

IV. Provider business mailing address

2700 CORAL RIDGE AVENUE IMCC
CORALVILLE IA
52241
US

V. Phone/Fax

Practice location:
  • Phone: 319-626-2391
  • Fax: 319-665-6721
Mailing address:
  • Phone: 319-626-2391
  • Fax: 319-665-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18517
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: