Healthcare Provider Details

I. General information

NPI: 1861474520
Provider Name (Legal Business Name): FRANK MICHAEL DE MAYO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W EATON AVE STE E
TRACY CA
95376-3455
US

IV. Provider business mailing address

793 S TRACY BLVD STE 332
TRACY CA
95376-4753
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-4888
  • Fax: 209-835-6424
Mailing address:
  • Phone: 209-835-4888
  • Fax: 209-835-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG60003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG60003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: