Basic Information
| Provider Information | |||||||||
| NPI: | 1679740146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIA HEROPOULOS, M.D., INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2415 CAMPUS DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926121527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499993600 | ||||||||
| FaxNumber: | 9499993648 | ||||||||
| Practice Location | |||||||||
| Address1: | 27882 FORBES RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LAGUNA NIGUEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926771267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493472400 | ||||||||
| FaxNumber: | 9493472424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 02/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | HEROPOULOS | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9493472400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G69241 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | G69241 | 01 | CA | MEDICAL LICENSE | OTHER |