Healthcare Provider Details

I. General information

NPI: 1649193970
Provider Name (Legal Business Name): GONG NASHED PASCOE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16800 NANETTE ST
GRANADA HILLS CA
91344-1812
US

IV. Provider business mailing address

16800 NANETTE ST
GRANADA HILLS CA
91344-1812
US

V. Phone/Fax

Practice location:
  • Phone: 818-312-6220
  • Fax:
Mailing address:
  • Phone: 818-312-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES VARGHESE MATHEW
Title or Position: DIRECTOR
Credential:
Phone: 818-312-6220