Provider Demographics
NPI:1972544088
Name:AFTONOMOS, LEFKOS B (MD)
Entity type:Individual
Prefix:DR
First Name:LEFKOS
Middle Name:B
Last Name:AFTONOMOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:730 POLHEMUS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3976
Mailing Address - Country:US
Mailing Address - Phone:650-356-0076
Mailing Address - Fax:650-349-2762
Practice Address - Street 1:34 N SAN MATEO DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2824
Practice Address - Country:US
Practice Address - Phone:650-513-6651
Practice Address - Fax:650-350-4395
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2014-12-23
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Provider Licenses
StateLicense IDTaxonomies
CAG37819208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G378190Medicaid
CA00G378190Medicaid
CAZZZ20098ZMedicare ID - Type Unspecified