Provider Demographics
NPI:1821317843
Name:DILYDIS INC
Entity Type:Organization
Organization Name:DILYDIS INC
Other - Org Name:CLINICA SAN FERNANDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGGIODICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:956-502-5513
Mailing Address - Street 1:3908 N JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7768
Mailing Address - Country:US
Mailing Address - Phone:956-502-5513
Mailing Address - Fax:956-502-5514
Practice Address - Street 1:3908 N. JACKSON RD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-502-5513
Practice Address - Fax:956-502-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03948261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217614101Medicaid