Provider Demographics
NPI:1386678209
Name:DIZON-LADIA, LILIA (MD)
Entity type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:
Last Name:DIZON-LADIA
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 1:210 NE 19TH DR
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1932
Mailing Address - Country:US
Mailing Address - Phone:863-763-6431
Mailing Address - Fax:863-763-2319
Practice Address - Street 1:208 & 210 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEC
Practice Address - State:FL
Practice Address - Zip Code:34972-1932
Practice Address - Country:US
Practice Address - Phone:863-763-6431
Practice Address - Fax:863-763-2319
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0022705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47027XOtherBCBS FLA
FL069748600Medicaid
FL1386678209OtherRAILROAD MEDICARE
FL47027XOtherBCBS FLA
FL069748600Medicaid