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General NPI Number Information
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NPI Number | 1902456379
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Entity Type | Organization
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Legal Business Name | TRACY ORTHOPEDICS AND SPORTS MEDICAL CENTER
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 530 W EATON AVE STE E
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City | TRACY
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State | CA
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Zip | 95376-3455
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Country | US
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Telephone | 209-835-4888
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Fax | 209-835-6424
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Provider Business Mailing Address
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Address Line | 793 S TRACY BLVD STE 332
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City | TRACY
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State | CA
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Zip | 95376-4753
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Country | US
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Telephone | 209-835-4888
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Fax | 209-835-6424
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Authorized Official
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Title or Position | PREDIDENT
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Name | FRANK MICHAEL DE MAYO
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Credential | MD
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Telephone | 209-835-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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