Provider Demographics
NPI:1114957479
Name:DIONISIO, ANGELITO J (MD)
Entity Type:Individual
Prefix:
First Name:ANGELITO
Middle Name:J
Last Name:DIONISIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10777 W TWAIN AVENUE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:702-839-0946
Mailing Address - Fax:702-839-0149
Practice Address - Street 1:2365 REYNOLDS AVENUE
Practice Address - Street 2:BUILDING C 2ND FLOOR
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-839-0946
Practice Address - Fax:702-839-0149
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPENDING207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9086562017OtherSUMMIT