Provider Demographics
NPI:1932308137
Name:DISCEPOLO, WILLIAM LEONARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEONARD
Last Name:DISCEPOLO
Suffix:II
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 1:3235 E COLORADO BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3849
Mailing Address - Country:US
Mailing Address - Phone:626-577-7050
Mailing Address - Fax:
Practice Address - Street 1:3235 E COLORADO BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3849
Practice Address - Country:US
Practice Address - Phone:310-896-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85753207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7418139Medicaid
CA7418139Medicaid
CACK414AMedicare PIN
CABX542TMedicare PIN
CA1932308137Medicaid
CA7418139Medicaid