Provider Demographics
NPI:1710154661
Name:GEORGE SAKOULAS MD, INC.
Entity Type:Organization
Organization Name:GEORGE SAKOULAS MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-481-6431
Mailing Address - Street 1:7910 FROST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2771
Mailing Address - Country:US
Mailing Address - Phone:858-292-4211
Mailing Address - Fax:858-292-7117
Practice Address - Street 1:7910 FROST ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2771
Practice Address - Country:US
Practice Address - Phone:858-292-4211
Practice Address - Fax:858-292-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101504207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G84868Medicare UPIN