Provider Demographics
NPI:1275089419
Name:VASILOMANOLAKIS, CONSTANTINE
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:VASILOMANOLAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MALAGA COVE PLZ STE 202
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-6813
Mailing Address - Country:US
Mailing Address - Phone:562-881-7195
Mailing Address - Fax:
Practice Address - Street 1:36 MALAGA COVE PLZ STE 202
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-6813
Practice Address - Country:US
Practice Address - Phone:562-881-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist