Provider Demographics
NPI:1679680664
Name:DELALLO, CHRISTOPHER JOHN (MPAS,PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:DELALLO
Suffix:
Gender:M
Credentials:MPAS,PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4502 MEDICAL DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-358-0265
Mailing Address - Fax:210-358-8451
Practice Address - Street 1:4502 MEDICAL DR FL 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-0265
Practice Address - Fax:210-358-8451
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02829363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183827802Medicaid
TX183827803OtherCSHCN