Provider Demographics
NPI:1679542518
Name:FOTINAKES, PETER ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:FOTINAKES
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 1:1010 W LA VETA AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4312
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:
Practice Address - Street 1:1010 W LA VETA AVE STE 750
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4312
Practice Address - Country:US
Practice Address - Phone:714-639-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG482272084N0400X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG5665OtherRAIL ROAD MEDICARE - GROUP PTAN
CA1912919804OtherTYPE 2 NPI
1912919804OtherNPI - TYPE 2
CA130025839OtherRAIL ROAD MEDICARE - PROVIDER PTAN
CACG5665OtherRAIL ROAD MEDICARE - GROUP PTAN
CAWG48227EMedicare PIN
CAW1514Medicare PIN
CAW1514OtherMEDICARE PTAN - TYPE 2
1679733190OtherNPI - TYPE 2
CABE622YMedicare PIN