Provider Demographics
NPI:1336178128
Name:PERDIKIS, GEORGE C (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:C
Last Name:PERDIKIS
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 1:1669 W. AVE-J
Mailing Address - Street 2:SUITE #308
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-940-5155
Mailing Address - Fax:661-940-5157
Practice Address - Street 1:1669 W. AVE-J
Practice Address - Street 2:SUITE #308
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-940-5155
Practice Address - Fax:661-940-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59579173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1703Medicare UPIN
CA006G595790Medicare ID - Type Unspecified
CAG59579Medicare ID - Type Unspecified