1144411414 NPI number — DR. THEODORE COUTSOFTIDES MD

Table of content: DR. THEODORE COUTSOFTIDES MD (NPI 1144411414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144411414 NPI number — DR. THEODORE COUTSOFTIDES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUTSOFTIDES
Provider First Name:
THEODORE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1144411414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4061 MORNING STAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92649-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-336-7949
Provider Business Mailing Address Fax Number:
714-840-6314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4061 MORNING STAR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92649-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-336-7949
Provider Business Practice Location Address Fax Number:
714-840-6314
Provider Enumeration Date:
08/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  A031348 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A031348 . This is a "LICENCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 020038943 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".