Healthcare Provider Details

I. General information

NPI: 1528678182
Provider Name (Legal Business Name): PAUL PETER ELIOPOULOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 BUSINESS CENTER DR
FAIRFIELD CA
94534-1696
US

IV. Provider business mailing address

18810 BUREN PL
CASTRO VALLEY CA
94552-5271
US

V. Phone/Fax

Practice location:
  • Phone: 707-224-8266
  • Fax:
Mailing address:
  • Phone: 510-938-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: