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1033541966
GENESISJAMES BASILIO DIZON
SAN DIEGO, CA
NPI
1033541966
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider Independent Duty Corpsman
Enumeration Date
2013-08-01
Last Update Date
2013-08-01
Business Address
MR. GENESISJAMES BASILIO DIZON SFIDC
3167 SAINT CHARLES ST
SAN DIEGO, CA 92110-4861
Phone number: 661-370-8688
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Mailing Address
MR. GENESISJAMES BASILIO DIZON SFIDC
3167 SAINT CHARLES ST
SAN DIEGO, CA 92110-4861
Phone number: 661-370-8688
Copy
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