Provider Demographics
NPI:1346394376
Name:THEODOROS M DASKALAKIS, M.D., INC
Entity Type:Organization
Organization Name:THEODOROS M DASKALAKIS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODOROS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DASKALAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-792-0978
Mailing Address - Street 1:1325 N ROSE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3919
Mailing Address - Country:US
Mailing Address - Phone:714-792-0978
Mailing Address - Fax:714-201-1303
Practice Address - Street 1:1325 N ROSE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3800
Practice Address - Country:US
Practice Address - Phone:714-792-0978
Practice Address - Fax:714-203-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90653208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI35747Medicare UPIN