Provider Demographics
NPI:1104912062
Name:ECONOMOU, VASILIKI (MD)
Entity type:Individual
Prefix:
First Name:VASILIKI
Middle Name:
Last Name:ECONOMOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27206 CALAROGA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4300
Mailing Address - Country:US
Mailing Address - Phone:510-783-7891
Mailing Address - Fax:510-783-6963
Practice Address - Street 1:27206 CALAROGA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4300
Practice Address - Country:US
Practice Address - Phone:510-783-7891
Practice Address - Fax:510-783-6963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA448792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A448791Medicaid
CA00A448791Medicaid
CAE42713Medicare UPIN