Provider Demographics
NPI:1174880835
Name:DIEGO F FERRO MD INC
Entity type:Organization
Organization Name:DIEGO F FERRO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-948-1583
Mailing Address - Street 1:420 W ACACIA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2441
Mailing Address - Country:US
Mailing Address - Phone:209-948-1583
Mailing Address - Fax:209-948-3564
Practice Address - Street 1:420 W ACACIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2441
Practice Address - Country:US
Practice Address - Phone:209-948-1583
Practice Address - Fax:209-948-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174880835Medicaid
CA1174880835Medicaid