Healthcare Provider Details

I. General information

NPI: 1336106665
Provider Name (Legal Business Name): ALFRED M PASCUAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD
NORTHRIDGE CA
91328
US

IV. Provider business mailing address

PO BOX 12410
WESTMINSTER CA
92685-1241
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-8500
  • Fax:
Mailing address:
  • Phone: 866-234-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A5182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: