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General NPI Number Information
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NPI Number | 1376885475
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Entity Type | Individual
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Provider Name | DIANA DIZIK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 669 CRESPI DR SUITE F
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City | PACIFICA
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State | CA
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Zip | 94044-3486
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Country | US
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Telephone | 650-359-1646
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Fax |
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Provider Business Mailing Address
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Address Line | 669 CRESPI DR SUITE F
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City | PACIFICA
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State | CA
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Zip | 94044-3486
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Country | US
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Telephone | 650-359-1646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 51471
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License Number State | CA
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