MEDICARE: DIONISIO TREJO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	268408	NY
2	208000000X	Pediatrics Physician	54679	AZ
3	208000000X	Pediatrics Physician	52974	CT

General Provider Information

NPI Number	:	1730394792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONISIO TREJO MD

Provider Business Mailing Address
First Line	:	3033 N CENTRAL AVE STE 145
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2808
Country	:	US
Telephone Number	:	623-583-3001
Fax Number	:	623-583-3007

Provider Business Practice Location Address
First Line	:	15525 N 83RD AVE STE 104
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-5820
Country	:	US
Telephone Number	:	877-809-5092
Fax Number	:	623-505-3272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	01/16/2019

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Directions to “ DIONISIO TREJO MD” Practice Location

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