Healthcare Provider Details

I. General information

NPI: 1568452704
Provider Name (Legal Business Name): THEODOR STEPHEN PARADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SULLIVAN AVE STE 310
DALY CITY CA
94015-2204
US

IV. Provider business mailing address

PO BOX 1442
PACIFICA CA
94044-6442
US

V. Phone/Fax

Practice location:
  • Phone: 650-757-2121
  • Fax: 650-757-2124
Mailing address:
  • Phone: 650-757-2121
  • Fax: 650-757-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA41695
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA41695
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA41695
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA41695
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA41695
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberA41695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: