Provider Demographics
NPI:1932112588
Name:CHASSIAKOS, YOLANDA REID (MD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:REID
Last Name:CHASSIAKOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:STASSINOPOULOS
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 15465
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-0465
Mailing Address - Country:US
Mailing Address - Phone:818-677-3689
Mailing Address - Fax:
Practice Address - Street 1:18111 NORDHOFF ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8270
Practice Address - Country:US
Practice Address - Phone:818-677-3689
Practice Address - Fax:818-677-5225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G56498Medicaid