Provider Demographics
NPI:1811045826
Name:MOULIOS, STEVEN THEODORE (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:THEODORE
Last Name:MOULIOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 J ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2325
Mailing Address - Country:US
Mailing Address - Phone:916-322-0124
Mailing Address - Fax:916-324-5960
Practice Address - Street 1:501 J ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2325
Practice Address - Country:US
Practice Address - Phone:916-322-0124
Practice Address - Fax:916-324-5960
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX69130Medicaid
H06181Medicare UPIN