Basic Information
| Provider Information | |||||||||
| NPI: | 1184647893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAKOULAS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 GENESEE AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586168091 | ||||||||
| FaxNumber: | 8586168090 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194461727 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 225011 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | A101504 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 00000092881 | 01 | NY | GHI HMO | OTHER | 1530027 | 01 | NY | AETNA HMO | OTHER | 5699722 | 01 | NY | GHI PPO | OTHER | 225011 | 01 | NY | CONNECTICARE | OTHER | 317AF1 | 01 | NY | EMPIRE BCBS | OTHER | 7480288 | 01 | NY | AETNA PPO | OTHER | 391737 | 01 | NY | MVP | OTHER | 225011 | 01 | NY | HIP | OTHER | P00290798 | 01 | NY | RAILROAD MEDICARE | OTHER | SG5011 | 01 | NY | ATLANTIS | OTHER | 02280275 | 05 | NY | MEDICAID |