Healthcare Provider Details

I. General information

NPI: 1861305898
Provider Name (Legal Business Name): BANDA BERRY HEALTH SERVICES, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S LOS ROBLES AVE STE 850
PASADENA CA
91101-4630
US

IV. Provider business mailing address

150 S LOS ROBLES AVE STE 850
PASADENA CA
91101-4630
US

V. Phone/Fax

Practice location:
  • Phone: 818-275-2304
  • Fax:
Mailing address:
  • Phone: 818-275-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN BERRY
Title or Position: FOUNDER, CEO
Credential: MD
Phone: 818-275-2304