Provider Demographics
NPI:1033808308
Name:KOUTZMBIS, ASPASIA (BA)
Entity Type:Individual
Prefix:MRS
First Name:ASPASIA
Middle Name:
Last Name:KOUTZMBIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ASPASIA
Other - Middle Name:
Other - Last Name:CHARALAMPOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2445 TRUXTUN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6153
Mailing Address - Country:US
Mailing Address - Phone:619-633-2119
Mailing Address - Fax:
Practice Address - Street 1:2445 TRUXTUN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6153
Practice Address - Country:US
Practice Address - Phone:619-633-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician