Provider Demographics
NPI:1063591469
Name:DYOCO, ORLANTINO GUTIERREZ (MD)
Entity type:Individual
Prefix:DR
First Name:ORLANTINO
Middle Name:GUTIERREZ
Last Name:DYOCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1124
Mailing Address - Country:US
Mailing Address - Phone:559-243-0418
Mailing Address - Fax:559-248-9253
Practice Address - Street 1:3006 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1124
Practice Address - Country:US
Practice Address - Phone:559-243-0418
Practice Address - Fax:559-248-9253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346430Medicaid
CAF50664Medicare UPIN