Healthcare Provider Details

I. General information

NPI: 1417247255
Provider Name (Legal Business Name): DIONESIA ADRAKTAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8288 BONITO CIR
ELK GROVE CA
95757-6273
US

IV. Provider business mailing address

816 W CANNON ST
FORT WORTH TX
76104-3146
US

V. Phone/Fax

Practice location:
  • Phone: 817-321-0937
  • Fax:
Mailing address:
  • Phone: 817-321-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number141819
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR3461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: