Provider Demographics
NPI:1912998071
Name:THEODOR S. PARADA, M.D., INC
Entity Type:Organization
Organization Name:THEODOR S. PARADA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-716-6145
Mailing Address - Street 1:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-6442
Mailing Address - Country:US
Mailing Address - Phone:650-757-2121
Mailing Address - Fax:650-757-2124
Practice Address - Street 1:1850 SULLIVAN AVE STE 310
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-757-2121
Practice Address - Fax:650-757-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084140Medicaid
CAA29437Medicare UPIN
CAGR0084140Medicaid