Healthcare Provider Details

I. General information

NPI: 1245927896
Provider Name (Legal Business Name): PATRICK DE DIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 CUSTOMER CARE WAY
ATWATER CA
95301-5167
US

IV. Provider business mailing address

2230 MIRA MONTE ST
CORONA CA
92879-7703
US

V. Phone/Fax

Practice location:
  • Phone: 209-930-5639
  • Fax:
Mailing address:
  • Phone: 951-476-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA205542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: