Organization
TRACY DERMATOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
N CHARLES DIAKON DO (OWNER)
(209) 836-2220
Entity
Organization
Contact information
Practice address
1470 BESSIE AVE, TRACY, CA 95376-3417
(209) 836-2220
(209) 836-0726
Mailing address
1470 BESSIE AVE, TRACY, CA 95376-3417
(209) 836-2220
(209) 836-0726
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20A4430
CA
207N00000X
Dermatology Physician
G49728
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX44430
—
CA
Enumeration date
07/28/2005
Last updated
08/22/2020
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