Provider Demographics
NPI:1851473003
Name:VLACHONASSIOS, KONSTANTINOS (MD)
Entity Type:Individual
Prefix:
First Name:KONSTANTINOS
Middle Name:
Last Name:VLACHONASSIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 LA REINA AVE # 201
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4237
Mailing Address - Country:US
Mailing Address - Phone:562-622-9500
Mailing Address - Fax:562-622-9513
Practice Address - Street 1:11101 LA REINA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4237
Practice Address - Country:US
Practice Address - Phone:562-622-9500
Practice Address - Fax:562-622-9513
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52738207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A5278380Medicaid
CAWA52738DMedicare ID - Type Unspecified
CA00A5278380Medicaid