Provider Demographics
NPI:1255319018
Name:PSYCHOGIOS, APOSTOLOS (MD)
Entity Type:Individual
Prefix:
First Name:APOSTOLOS
Middle Name:
Last Name:PSYCHOGIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S BUENA VISTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4504
Mailing Address - Country:US
Mailing Address - Phone:818-748-4761
Mailing Address - Fax:818-748-4761
Practice Address - Street 1:181 S BUENA VISTA ST STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4504
Practice Address - Country:US
Practice Address - Phone:818-748-4761
Practice Address - Fax:818-748-4761
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC180935207SG0201X
MN50441207SG0201X
OH35.086780207SG0201X
TNMD48069207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0153125Medicaid
MN634695100Medicaid