Provider Demographics
NPI:1639303951
Name:PETER N. SFAKIANOS, M.D., INC.
Entity Type:Organization
Organization Name:PETER N. SFAKIANOS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:SFAKIANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-984-4500
Mailing Address - Street 1:1580 CREEKSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3886
Mailing Address - Country:US
Mailing Address - Phone:916-984-4500
Mailing Address - Fax:916-984-4502
Practice Address - Street 1:1580 CREEKSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3886
Practice Address - Country:US
Practice Address - Phone:916-984-4500
Practice Address - Fax:916-984-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52972207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G529721Medicaid
CA00G529721Medicaid
CAB57949Medicare UPIN