NPIMap

Organization Active NPI

Dimitri Sirakoff D.O., Inc

Doing business as Santa Ana Health Group and Medical Associates

  • Physician Assistant
  • Santa Ana, CA
National Provider Identifier
1104076256
Registry record updated Sep 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19687 Issued in CA
Legal business name
DIMITRI SIRAKOFF D.O., INC
Doing business as
Santa Ana Health Group and Medical Associates
Practice address
1206 E 17TH Street
Suite 204
Santa Ana, CA 92701-2341
Phone
(714) 835-3500
Fax
(714) 835-4619
NPI assigned
Sep 25, 2008
Last updated
Sep 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marty Sillasen
Title
Office Manager
Phone
(714) 835-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA19687 CA Primary

Addresses

Primary practice location

1206 E 17TH Street
Suite 204
Santa Ana, CA 92701-2341

Mailing address

1206 E 17TH Street
Suite 204
Santa Ana, CA 92701-2341
Phone (714) 835-3500

Other names 1

  • Santa Ana Health Group and Medical Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dimitri Sirakoff DO Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222300800000",
    "number": "1104076256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 E 17TH STREET",
            "address_2": "SUITE 204",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012341",
            "telephone_number": "714-835-3500",
            "fax_number": "714-835-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 E 17TH STREET",
            "address_2": "SUITE 204",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927012341",
            "telephone_number": "714-835-3500",
            "fax_number": "714-835-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIMITRI SIRAKOFF D.O., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2008-09-25",
        "status": "A",
        "authorized_official_last_name": "SILLASEN",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "714-835-3500"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Ana Health Group and Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.