Healthcare Provider Details

I. General information

NPI: 1225772833
Provider Name (Legal Business Name): NIKOLAOS SARANTOPOULOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

11234 ANDERSON ST LOMA LINDA CA 92354
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 877-558-6248
  • Fax:
Mailing address:
  • Phone: 413-794-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A22013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: