Provider Demographics
NPI:1902891724
Name:DIZON, LUZ EVANGELINE SALUD (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ EVANGELINE
Middle Name:SALUD
Last Name:DIZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:MOAK ASSOCIATES
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-0260
Mailing Address - Country:US
Mailing Address - Phone:508-898-8650
Mailing Address - Fax:508-870-9397
Practice Address - Street 1:235 N PEARL ST
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1794
Practice Address - Country:US
Practice Address - Phone:508-427-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA810522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24338OtherFEDERAL BC/BS
MAJ24338OtherBC/BS OF MASSACHUSETTS
MAJ24338OtherBLUE CARD
MAO159140Medicaid
MA000000026002OtherHEALTHNET/BMC
MA0026396OtherNEIGHBORHOOD HEALTH PLAN
MAA33458Medicare PIN
MA0026396OtherNEIGHBORHOOD HEALTH PLAN
MA000000026002OtherHEALTHNET/BMC