# TRACY ORTHOPEDICS AND SPORTS MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TRACY ORTHOPEDICS AND SPORTS MEDICAL CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902456379
- **Authorized official:** FRANK MICHAEL DE MAYO MD (PREDIDENT)
- **Authorized official phone:** (209) 835-4888

## Contact information

- **Practice address:** 530 W EATON AVE STE E, TRACY, CA 95376-3455
- **Practice address phone:** (209) 835-4888
- **Practice address fax:** (209) 835-6424
- **Mailing address:** 793 S TRACY BLVD STE 332, TRACY, CA 95376-4753
- **Mailing address phone:** (209) 835-4888
- **Mailing address fax:** (209) 835-6424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |
| 2251S0007X | Sports Physical Therapist | — | NULL | — |
| 2251S0007X | Sports Physical Therapist | — | — | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 09/17/2019
- **Last updated:** 04/21/2023