Provider Demographics
NPI:1972267003
Name:SPEROS, VASILLIOS F
Entity Type:Individual
Prefix:
First Name:VASILLIOS
Middle Name:F
Last Name:SPEROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N MESA DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5913
Mailing Address - Country:US
Mailing Address - Phone:602-531-5141
Mailing Address - Fax:
Practice Address - Street 1:456 N MESA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5913
Practice Address - Country:US
Practice Address - Phone:602-531-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator