Provider Demographics
NPI:1265445993
Name:DIABLO NEUROSURGICAL MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:DIABLO NEUROSURGICAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-937-0404
Mailing Address - Street 1:122 LA CASA VIA STE 222
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3014
Mailing Address - Country:US
Mailing Address - Phone:925-937-0404
Mailing Address - Fax:925-937-1340
Practice Address - Street 1:122 LA CASA VIA STE 222
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3014
Practice Address - Country:US
Practice Address - Phone:925-937-0404
Practice Address - Fax:925-937-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ72795ZOtherBLUE SHIELD OF CA
C41006OtherRAILROAD MEDICARE
C41006OtherRAILROAD MEDICARE