1033875448 NPI number — CORNERSTONE REHABILITATION OF UNIV-OXF-LAF

Table of content: DR. MARIA ANGELA DIZON MD (NPI 1386632271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033875448 NPI number — CORNERSTONE REHABILITATION OF UNIV-OXF-LAF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE REHABILITATION OF UNIV-OXF-LAF
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033875448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATER VALLEY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38965-2946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-473-1667
Provider Business Mailing Address Fax Number:
662-714-4140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201A OFFICE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-3598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-371-1987
Provider Business Practice Location Address Fax Number:
662-371-1989
Provider Enumeration Date:
11/10/2021

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
662-473-1667

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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