Provider Demographics
NPI:1528110343
Name:DIZON, VICTOR VALDECANAS (DO)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:VALDECANAS
Last Name:DIZON
Suffix:
Gender:M
Credentials:DO
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 4
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-0004
Mailing Address - Country:US
Mailing Address - Phone:614-462-7894
Mailing Address - Fax:614-884-1632
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4354
Practice Address - Country:US
Practice Address - Phone:614-462-7894
Practice Address - Fax:614-884-1632
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2318003Medicaid
OH4082791Medicare PIN
OHH61563Medicare UPIN
OH4082793Medicare ID - Type Unspecified