Provider Demographics
NPI:1457440083
Name:VASILOMANOLAKIS, EMMANUEL CONSTANTINE (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:CONSTANTINE
Last Name:VASILOMANOLAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EMMANUEL
Other - Middle Name:MIKE
Other - Last Name:VASILOMANOLAKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1240 E 29TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1824
Mailing Address - Country:US
Mailing Address - Phone:562-494-3547
Mailing Address - Fax:562-986-4467
Practice Address - Street 1:1760 TERMINO AVENUE
Practice Address - Street 2:SUITE 314
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-494-3547
Practice Address - Fax:562-986-4467
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41023207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA009410230Medicaid
CA009410230Medicaid
CAG41023Medicare PIN