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General NPI Number Information
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NPI Number | 1851473003
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Entity Type | Individual
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Provider Name | KONSTANTINOS VLACHONASSIOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3300 E SOUTH ST STE 301
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City | LAKEWOOD
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State | CA
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Zip | 90805-4561
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Country | US
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Telephone | 562-622-9500
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Fax | 562-622-9513
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Provider Business Mailing Address
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Address Line | 19051 GOLDENWEST ST # 106-321
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-2155
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Country | US
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Telephone | 562-622-9500
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Fax | 562-622-9513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A52738
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License Number State | CA
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