Provider Demographics
NPI:1457407314
Name:PILUMELI DI BLASI, TINA (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PILUMELI DI BLASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2860
Mailing Address - Country:US
Mailing Address - Phone:830-703-8555
Mailing Address - Fax:830-703-8334
Practice Address - Street 1:3809 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2860
Practice Address - Country:US
Practice Address - Phone:830-703-8555
Practice Address - Fax:830-703-8334
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7952207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K9391OtherBCBS
TX171255601Medicaid
TX8K9391OtherBCBS
TXG17374Medicare UPIN