Healthcare Provider Details

I. General information

NPI: 1003466533
Provider Name (Legal Business Name): KATARINA VAMVOURIS PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E ST STE B
DAVIS CA
95616-4523
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 530-206-9996
  • Fax:
Mailing address:
  • Phone: 916-576-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: