1184647893 NPI number — GEORGE SAKOULAS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184647893 NPI number — GEORGE SAKOULAS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SAKOULAS

Provider First Name:

GEORGE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1184647893

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/29/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2020 GENESEE AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN DIEGO

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

92123-4219

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

858-616-8091

Provider Business Mailing Address Fax Number:

858-616-8090

Provider First Line Business Practice Location Address:

2001 4TH AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAN DIEGO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

92101-2303

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

619-446-1727

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RI0200X , with the licence number:  225011 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RI0200X , with the licence number: A101504 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00000092881 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1530027 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5699722 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 225011 . This is a "CONNECTICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 317AF1 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7480288 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 391737 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 225011 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P00290798 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: SG5011 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02280275 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".