Healthcare Provider Details

I. General information

NPI: 1295979144
Provider Name (Legal Business Name): PATTY MORELL DIBLASIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 VIA PAQUETE
SAN CLEMENTE CA
92673-6915
US

IV. Provider business mailing address

12 VIA PAQUETE
SAN CLEMENTE CA
92673-6915
US

V. Phone/Fax

Practice location:
  • Phone: 949-325-6164
  • Fax: 949-649-1058
Mailing address:
  • Phone: 949-328-6164
  • Fax: 949-649-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA123970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: