Provider Demographics
NPI:1568452704
Name:PARADA, THEODOR STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:THEODOR
Middle Name:STEPHEN
Last Name:PARADA
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:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-6442
Mailing Address - Country:US
Mailing Address - Phone:650-757-2121
Mailing Address - Fax:650-757-2124
Practice Address - Street 1:1850 SULLIVAN AVE STE 310
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-757-2121
Practice Address - Fax:650-757-2124
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41695207RC0200X, 208600000X, 208M00000X, 208VP0000X, 209800000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416950Medicaid
CA00A416950Medicare ID - Type Unspecified
CAA29437Medicare UPIN
CA00A416951Medicare PIN