Healthcare Provider Details

I. General information

NPI: 1942336474
Provider Name (Legal Business Name): ELEFTHERIOS CHRISTOS VAMVAKAS M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
LOS ANGELES CA
90048-1804
US

IV. Provider business mailing address

31255 CEDAR VALLEY DR STE 324
WEST LAKE VILLAGE CA
91362-7129
US

V. Phone/Fax

Practice location:
  • Phone: 914-834-1564
  • Fax:
Mailing address:
  • Phone: 818-338-8103
  • Fax: 818-338-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number73588
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: