Healthcare Provider Details

I. General information

NPI: 1174106835
Provider Name (Legal Business Name): THANOS GEORGE ROSSOPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 PRECISION PARK LN
SAN YSIDRO CA
92173-1346
US

IV. Provider business mailing address

200 DICKINSON MC 8218
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-600-4870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA182392
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA182392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: