Provider Demographics
NPI:1598990327
Name:KOLLAROS, DIMITRIS (CCSS WORKER)
Entity Type:Individual
Prefix:MR
First Name:DIMITRIS
Middle Name:
Last Name:KOLLAROS
Suffix:
Gender:M
Credentials:CCSS WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1714
Mailing Address - Country:US
Mailing Address - Phone:575-640-3537
Mailing Address - Fax:
Practice Address - Street 1:1100 S. MAIN
Practice Address - Street 2:EXECUTIVE SUITES
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:575-525-5635
Practice Address - Fax:575-647-8804
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator