Healthcare Provider Details

I. General information

NPI: 1275532301
Provider Name (Legal Business Name): PAUL MAISTROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL MAISTROS M.D.

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WARNER AVE SUITE 121
FOUNTAIN VALLEY CA
92708-4008
US

IV. Provider business mailing address

PO BOX 20139
FOUNTAIN VALLEY CA
92728-0139
US

V. Phone/Fax

Practice location:
  • Phone: 714-437-1246
  • Fax: 714-437-1354
Mailing address:
  • Phone: 714-437-1246
  • Fax: 714-437-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA44496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: