Provider Demographics
NPI:1003466533
Name:VAMVOURIS, SOTIRIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SOTIRIA
Middle Name:
Last Name:VAMVOURIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8886
Mailing Address - Country:US
Mailing Address - Phone:925-719-2876
Mailing Address - Fax:
Practice Address - Street 1:3061 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8886
Practice Address - Country:US
Practice Address - Phone:925-719-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist