Vicki C Petropoulos, DMD, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

62346 Issued in CA

Practice address

1525 4TH Ave
San Diego, CA 92101-3107

Phone

(619) 795-1301

NPI assigned

Oct 31, 2007

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685

  CA

  Medicare reassignment NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1326225632
  NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vpetropoulos48431@syhealth.direct-ci.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 22, 2023.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1982883575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7308",
            "city": "RANCHO SANTA FE",
            "state": "CA",
            "postal_code": "920677308",
            "telephone_number": "267-342-0372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013107",
            "telephone_number": "619-795-1301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "53000 Cahuilla Rd",
            "address_purpose": "LOCATION",
            "city": "Anza",
            "state": "CA",
            "postal_code": "925399142",
            "country_code": "US",
            "telephone_number": "951-763-4835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETROPOULOS",
        "first_name": "VICKI",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "PA",
            "license": "DS0276299-L",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "62346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karina Petrikowski Ortiz
• Kauanoe Shantel Petrill-Abrojina
• Jeanette Marie Petrini, LCSW
• Alex Petro, MSW, LCSW
• Anthony Petrone Jr., MA
• Petros Toma & Putrus Dental Corp
• Dhafir Jalal Petros
• Petros.Toma&Putrus Dental Corp
• Emilya Petrosyan
• Brandon Michael Petrovich, MD

• All providers in San Diego, CA
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.