Healthcare Provider Details

I. General information

NPI: 1841607835
Provider Name (Legal Business Name): REACH WELLNESS & RECOVERY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE SUITE 202
PASADENA CA
91101-2035
US

IV. Provider business mailing address

PO BOX 218
SOUTH PASADENA CA
91031-0218
US

V. Phone/Fax

Practice location:
  • Phone: 626-460-8710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ALIX NASSIRI
Title or Position: OWNER
Credential: D.O.
Phone: 951-529-7890