Provider Demographics
NPI:1619133972
Name:TRIANTOS, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:TRIANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15000 LOS GATOS BLVD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2017
Mailing Address - Country:US
Mailing Address - Phone:408-358-2624
Mailing Address - Fax:408-358-3375
Practice Address - Street 1:15000 LOS GATOS BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2017
Practice Address - Country:US
Practice Address - Phone:408-358-2624
Practice Address - Fax:408-358-3375
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 30669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics