Healthcare Provider Details

I. General information

NPI: 1114709904
Provider Name (Legal Business Name): KALLEOPE RHEA TOMPROS ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 ROSCOE BLVD
VAN NUYS CA
91406-1219
US

IV. Provider business mailing address

16650 SHERMAN WAY
VAN NUYS CA
91406-3782
US

V. Phone/Fax

Practice location:
  • Phone: 818-908-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW126533
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: