Healthcare Provider Details

I. General information

NPI: 1942277157
Provider Name (Legal Business Name): GERALDINE Y GATMAITAN DIZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GERALDINE DIZON MD

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 WRIGLEY DR STE 101
PASCO WA
99301-5292
US

IV. Provider business mailing address

520 N 4TH AVE
PASCO WA
99301-5257
US

V. Phone/Fax

Practice location:
  • Phone: 509-546-8399
  • Fax: 509-545-6842
Mailing address:
  • Phone: 509-416-8849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number053816
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60002198
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: