Basic Information
| Provider Information | |||||||||
| NPI: | 1467409250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DASKALAKIS | ||||||||
| FirstName: | THEODOROS | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 279 IMPERIAL HWY | ||||||||
| Address2: | SUITE 730 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928351041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144494841 | ||||||||
| FaxNumber: | 7144494956 | ||||||||
| Practice Location | |||||||||
| Address1: | 2141 N HARBOR BLVD | ||||||||
| Address2: | SUITE 35000 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146268630 | ||||||||
| FaxNumber: | 7146268659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 04/29/2013 | ||||||||
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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 | 174400000X | A90653 | CA | N | Other Service Providers | Specialist | 208600000X | A90653 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.