Healthcare Provider Details

I. General information

NPI: 1043340722
Provider Name (Legal Business Name): KATRINA M. VLACHOS, M. D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR #400
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

120 S SPALDING DR #400
BEVERLY HILLS CA
90212-1800
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-3409
  • Fax: 310-247-1750
Mailing address:
  • Phone: 310-860-3409
  • Fax: 310-247-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAO68888
License Number StateCA

VIII. Authorized Official

Name: KATRINA M VLACHOS
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 310-860-3409