Provider Demographics
NPI:1538243126
Name:TSOLAKOGLOU-WILLIAMS, CLEO (MD)
Entity type:Individual
Prefix:MRS
First Name:CLEO
Middle Name:
Last Name:TSOLAKOGLOU-WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:PROF
Other - First Name:ASCLEPION
Other - Middle Name:FAM
Other - Last Name:ASCLEPION FAM.MED.GRP.INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:208
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2401
Mailing Address - Country:US
Mailing Address - Phone:626-577-4455
Mailing Address - Fax:626-449-2759
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:626-577-4455
Practice Address - Fax:626-449-2759
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521910Medicaid
CA00A521910Medicaid
CAH06364Medicare UPIN