Provider Demographics
NPI:1730394792
Name:TREJO, DIONISIO (MD)
Entity type:Individual
Prefix:
First Name:DIONISIO
Middle Name:
Last Name:TREJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DIONISIO
Other - Middle Name:
Other - Last Name:TREJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3033 N CENTRAL AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2808
Mailing Address - Country:US
Mailing Address - Phone:623-583-3001
Mailing Address - Fax:623-583-3007
Practice Address - Street 1:15525 N 83RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5820
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:623-505-3272
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268408208000000X
AZ54679208000000X
CT52974208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02149017Medicaid
NY03652233Medicaid