Provider Demographics
NPI:1790079267
Name:REBELLO, DONNIA LILY (MD)
Entity Type:Individual
Prefix:
First Name:DONNIA
Middle Name:LILY
Last Name:REBELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:690 S LOOP 336 W FL 3
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3319
Mailing Address - Country:US
Mailing Address - Phone:936-522-4000
Mailing Address - Fax:936-522-4022
Practice Address - Street 1:690 S LOOP 336 W FL 3
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3319
Practice Address - Country:US
Practice Address - Phone:936-522-4000
Practice Address - Fax:936-522-4022
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3947207R00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics