Healthcare Provider Details

I. General information

NPI: 1780046813
Provider Name (Legal Business Name): THEODORE LUKE GERMANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 STEVENS AVE
SOLANA BEACH CA
92075-2075
US

IV. Provider business mailing address

462 STEVENS AVE
SOLANA BEACH CA
92075-2075
US

V. Phone/Fax

Practice location:
  • Phone: 858-365-8564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA174881
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA174881
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA174881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: