Provider Demographics
NPI:1275702797
Name:PAPATHEOFANIS, FRANK J
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:PAPATHEOFANIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DR
Mailing Address - Street 2:UCSD RADOP;PGU MC 8758
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8758
Mailing Address - Country:US
Mailing Address - Phone:619-543-6681
Mailing Address - Fax:619-543-1977
Practice Address - Street 1:200 WEST ARBOR DR
Practice Address - Street 2:UCSD RADOP;PGU MC 8758
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8758
Practice Address - Country:US
Practice Address - Phone:619-543-6681
Practice Address - Fax:619-543-1977
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81975207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G819750Medicaid
CAG20696Medicare UPIN
CAWG81975AMedicare PIN
CAWG81975BMedicare PIN