Healthcare Provider Details

I. General information

NPI: 1336178128
Provider Name (Legal Business Name): GEORGE C PERDIKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W. AVE-J SUITE #308
LANCASTER CA
93534
US

IV. Provider business mailing address

1669 W. AVE-J SUITE #308
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-5155
  • Fax: 661-940-5157
Mailing address:
  • Phone: 661-940-5155
  • Fax: 661-940-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG59579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: