MEDICARE: TASOULA VORVOLAKOS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	20A12727	CA

General Provider Information

NPI Number	:	1326466079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASOULA VORVOLAKOS DO

Provider Business Mailing Address
First Line	:	280 S EUCLID AVE
Second Line	:	APT # 222
City	:	PASADENA
State	:	CA
Zip	:	91101-2768
Country	:	US
Telephone Number	:	602-399-2583
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 S EUCLID AVE
Second Line	:	APT # 222
City	:	PASADENA
State	:	CA
Zip	:	91101-2768
Country	:	US
Telephone Number	:	602-399-2583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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