Provider Demographics
NPI:1578855680
Name:MANLLO DIECK, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MANLLO DIECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 1ST ST STE 600
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1228
Mailing Address - Country:US
Mailing Address - Phone:956-631-6136
Mailing Address - Fax:956-631-1848
Practice Address - Street 1:1901 S 1ST ST STE 600
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1228
Practice Address - Country:US
Practice Address - Phone:956-631-6136
Practice Address - Fax:956-631-1848
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301 098 223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine