Provider Demographics
NPI:1619903986
Name:MEDITERRANEAN MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MEDITERRANEAN MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAPERONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-680-0604
Mailing Address - Street 1:30 ACOMA BLVD S
Mailing Address - Street 2:101-103
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5957
Mailing Address - Country:US
Mailing Address - Phone:928-680-0604
Mailing Address - Fax:928-680-0605
Practice Address - Street 1:30 ACOMA BLVD S
Practice Address - Street 2:101-103
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5957
Practice Address - Country:US
Practice Address - Phone:928-680-0604
Practice Address - Fax:928-680-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB11043Medicare UPIN