Provider Demographics
NPI:1942336474
Name:VAMVAKAS, ELEFTHERIOS CHRISTOS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ELEFTHERIOS
Middle Name:CHRISTOS
Last Name:VAMVAKAS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31255 CEDAR VALLEY DR
Mailing Address - Street 2:STE 324
Mailing Address - City:WEST LAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7129
Mailing Address - Country:US
Mailing Address - Phone:818-338-8103
Mailing Address - Fax:818-338-8119
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:914-834-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73588207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF26916Medicare UPIN