Healthcare Provider Details

I. General information

NPI: 1275702797
Provider Name (Legal Business Name): DR. FRANK J PAPATHEOFANIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DR UCSD RADOP;PGU MC 8758
SAN DIEGO CA
92103-8758
US

IV. Provider business mailing address

200 WEST ARBOR DR UCSD RADOP;PGU MC 8758
SAN DIEGO CA
92103-8758
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6681
  • Fax: 619-543-1977
Mailing address:
  • Phone: 619-543-6681
  • Fax: 619-543-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG81975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: