Provider Demographics
NPI:1063757474
Name:N. CHARLES DIAKON D.O. A.P.C
Entity type:Organization
Organization Name:N. CHARLES DIAKON D.O. A.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:N.
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DIAKON
Authorized Official - Suffix:
Authorized Official - Credentials:D,O
Authorized Official - Phone:707-252-1393
Mailing Address - Street 1:3020 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-252-1393
Mailing Address - Fax:707-257-0923
Practice Address - Street 1:3020 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3442
Practice Address - Country:US
Practice Address - Phone:707-252-1393
Practice Address - Fax:707-257-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08764Medicare UPIN