Provider Demographics
NPI:1851510523
Name:DIONISIO, ODILLA (RN)
Entity Type:Individual
Prefix:MS
First Name:ODILLA
Middle Name:
Last Name:DIONISIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ODILLA
Other - Middle Name:LIM
Other - Last Name:DIONISIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2721 RALL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5042
Mailing Address - Country:US
Mailing Address - Phone:559-681-8274
Mailing Address - Fax:
Practice Address - Street 1:4411 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702
Practice Address - Country:US
Practice Address - Phone:559-538-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529051163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse