MEDICARE: ASCLEPION FAMILY MEDICAL GROUP INC.

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	261Q00000X	Clinic/Center	A52191	CA

General Provider Information

NPI Number	:	1790869113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCLEPION FAMILY MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	960 E GREEN ST
Second Line	:	208
City	:	PASADENA
State	:	CA
Zip	:	91106-2401
Country	:	US
Telephone Number	:	626-449-1944
Fax Number	:	626-449-2759

Provider Business Practice Location Address
First Line	:	960 E GREEN ST
Second Line	:	208
City	:	PASADENA
State	:	CA
Zip	:	91106-2401
Country	:	US
Telephone Number	:	626-449-1944
Fax Number	:	626-449-2759

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLEO TSOLAKOGLOU-WILLIAMS
Credential	:	M.D
Telephone Number	:	626-449-1944

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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