Healthcare Provider Details

I. General information

NPI: 1730394792
Provider Name (Legal Business Name): DIONISIO TREJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DIONISIO TREJO PA

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 N 83RD AVE STE 104
PEORIA AZ
85382-5820
US

IV. Provider business mailing address

3033 N CENTRAL AVE STE 145
PHOENIX AZ
85012-2808
US

V. Phone/Fax

Practice location:
  • Phone: 877-809-5092
  • Fax: 623-505-3272
Mailing address:
  • Phone: 623-583-3001
  • Fax: 623-583-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number268408
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54679
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52974
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: