Provider Demographics
NPI:1326466079
Name:VORVOLAKOS, TASOULA (DO)
Entity Type:Individual
Prefix:
First Name:TASOULA
Middle Name:
Last Name:VORVOLAKOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 S EUCLID AVE
Mailing Address - Street 2:APT # 222
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2768
Mailing Address - Country:US
Mailing Address - Phone:602-399-2583
Mailing Address - Fax:
Practice Address - Street 1:280 S EUCLID AVE
Practice Address - Street 2:APT # 222
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2768
Practice Address - Country:US
Practice Address - Phone:602-399-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics