Provider Demographics
NPI:1669457263
Name:DIONISIO, PAULA M (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:DIONISIO
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:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2749
Practice Address - Country:US
Practice Address - Phone:719-595-7680
Practice Address - Fax:719-595-7687
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33326207RG0100X
CO47552207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07536011Medicaid