Healthcare Provider Details

I. General information

NPI: 1538243126
Provider Name (Legal Business Name): CLEO TSOLAKOGLOU-WILLIAMS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PROF. ASCLEPION FAM. ASCLEPION FAM.MED.GRP.INC.

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST 208
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST 208
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-4455
  • Fax: 626-449-2759
Mailing address:
  • Phone: 626-577-4455
  • Fax: 626-449-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: