Provider Demographics
NPI:1245778240
Name:SOTIROPULOS, BASILIOS
Entity type:Individual
Prefix:
First Name:BASILIOS
Middle Name:
Last Name:SOTIROPULOS
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 1:3478 BUSKIRK AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3478 BUSKIRK AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4344
Practice Address - Country:US
Practice Address - Phone:925-943-1794
Practice Address - Fax:925-943-6091
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA123828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program