Provider Demographics
NPI:1902823974
Name:DE DIOS, ANGELITO O (MD)
Entity Type:Individual
Prefix:
First Name:ANGELITO
Middle Name:O
Last Name:DE DIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E RIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1619
Mailing Address - Country:US
Mailing Address - Phone:956-687-8223
Mailing Address - Fax:956-687-8225
Practice Address - Street 1:1301 E RIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1619
Practice Address - Country:US
Practice Address - Phone:956-687-8223
Practice Address - Fax:956-687-8225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6835207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096827304Medicaid
TX096827304Medicaid
TXG93422Medicare UPIN