MEDICARE: DIONESIA ADRAKTAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	141819	CA
2	2085R0202X	Diagnostic Radiology Physician	R3461	TX

General Provider Information

NPI Number	:	1417247255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONESIA ADRAKTAS MD

Provider Business Mailing Address
First Line	:	816 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3146
Country	:	US
Telephone Number	:	817-321-0937
Fax Number	:

Provider Business Practice Location Address
First Line	:	8288 BONITO CIR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-6273
Country	:	US
Telephone Number	:	817-321-0937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	11/20/2017

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