Provider Demographics
NPI:1790050896
Name:VLACHAKIS, NICOLAS DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:DENNIS
Last Name:VLACHAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLAS
Other - Middle Name:DENNIS
Other - Last Name:VLACHAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2378 TANOBLE DR
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2730
Mailing Address - Country:US
Mailing Address - Phone:626-794-8874
Mailing Address - Fax:626-794-8874
Practice Address - Street 1:2378 TANOBLE DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2730
Practice Address - Country:US
Practice Address - Phone:626-794-8874
Practice Address - Fax:626-794-8874
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE37623213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine