Individual
DR. DIMITRI J BACOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1080 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4296
Mailing address
1080 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4296
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A110160
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC 700 44F
SANTA CRUZ COUNTY, CALIFORNIA MEDI-CAL GROUP ID
CA
01
—
FHC70042F
SANTA CRUZ COUNTY, CALIFORNIA MEDI-CAL GROUP ID
CA
01
—
ZZZ91891Z
SANTA CRUZ COUNTY, CALIFORNIA MEDICARE GROUP PTAN #
CA
01
—
ZZZ91892Z
SANTA CRUZ COUNTY, CALIFORNIA MEDICARE GROUP PTAN #
CA
Enumeration date
01/12/2010
Last updated
02/19/2025
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