Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | IL |
NPI | 1710016571 |
---|---|
Provider Name | Dr. Lydia Dizon Jazmines |
First Address | Naperville, IL 60564-8331 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E-18449 | (02) |