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General NPI Number Information
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NPI Number | 1619903986
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Entity Type | Organization
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Legal Business Name | MEDITERRANEAN MENTAL HEALTH CENTER, INC.
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 30 ACOMA BLVD S 101-103
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5957
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Country | US
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Telephone | 928-680-0604
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Fax | 928-680-0605
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Provider Business Mailing Address
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Address Line | 30 ACOMA BLVD S 101-103
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5957
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Country | US
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Telephone | 928-680-0604
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Fax | 928-680-0605
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VASILIOS W. KAPERONIS
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Credential | M.D.
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Telephone | 928-680-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20732
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License Number State | AZ
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