Healthcare Provider Details

I. General information

NPI: 1700409760
Provider Name (Legal Business Name): PEARL BASALDUA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 308
PASADENA CA
91107-6649
US

IV. Provider business mailing address

4685 3RD ST
LA MESA CA
91941-5529
US

V. Phone/Fax

Practice location:
  • Phone: 877-622-0013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC20919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: