Provider Demographics
NPI:1154424190
Name:DIZON-SAMSON, RACQUEL DELA CRUZ (RN)
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:DELA CRUZ
Last Name:DIZON-SAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:DIZON
Other - Last Name:SAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:229 BRIDGEWATER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585
Mailing Address - Country:US
Mailing Address - Phone:707-427-1939
Mailing Address - Fax:707-427-1939
Practice Address - Street 1:229 BRIDGEWATER CIRCLE
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585
Practice Address - Country:US
Practice Address - Phone:707-427-1939
Practice Address - Fax:707-427-1939
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625156163WC0200X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health