Provider Demographics
NPI:1588362487
Name:RODAFINOS, GEORGIOS GEORGE (CMS)
Entity type:Individual
Prefix:
First Name:GEORGIOS
Middle Name:GEORGE
Last Name:RODAFINOS
Suffix:
Gender:M
Credentials:CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 E WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3175
Mailing Address - Country:US
Mailing Address - Phone:952-250-0957
Mailing Address - Fax:
Practice Address - Street 1:2010 E WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3175
Practice Address - Country:US
Practice Address - Phone:952-250-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist