Provider Demographics
NPI:1700027877
Name:FERRO, DIEGO F (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:F
Last Name:FERRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700027877Medicaid
CA1700027877Medicare PIN