Provider Demographics
NPI:1669648093
Name:DE DIOS, MADELINE CORTEZ (PTA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:CORTEZ
Last Name:DE DIOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 FRANK BLONDIN LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-6734
Mailing Address - Country:US
Mailing Address - Phone:209-740-9378
Mailing Address - Fax:
Practice Address - Street 1:2070 FRANK BLONDIN LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-6734
Practice Address - Country:US
Practice Address - Phone:209-740-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8359225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant