Healthcare Provider Details

I. General information

NPI: 1932382553
Provider Name (Legal Business Name): PAUL MAISTROS, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WARNER AVENUE SUITE 121
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

P.O. BOX 20139
FOUNTAIN VALLEY CA
92708
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: MRS. SUSAN ORTIZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-437-1246