Provider Demographics
NPI:1780689703
Name:DASKALOS, GEORGE HAROLD (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:HAROLD
Last Name:DASKALOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 PORTAGE BAY E
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3073
Mailing Address - Country:US
Mailing Address - Phone:530-756-3256
Mailing Address - Fax:530-756-3256
Practice Address - Street 1:2655 PORTAGE BAY E
Practice Address - Street 2:SUITE 10
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3073
Practice Address - Country:US
Practice Address - Phone:530-756-3256
Practice Address - Fax:530-756-3256
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA264963Medicare UPIN
CA231392000Medicare UPIN
CA0PL154001Medicare ID - Type UnspecifiedMEDICARE
CAZZZ62410ZMedicare UPIN
CA5422-00PL1540001Medicare UPIN