Healthcare Provider Details

I. General information

NPI: 1932008570
Provider Name (Legal Business Name): PASADENA OBSERVATION MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

PO BOX 60259
LOS ANGELES CA
90060-0259
US

V. Phone/Fax

Practice location:
  • Phone: 877-346-2211
  • Fax: 407-324-4727
Mailing address:
  • Phone: 877-346-2211
  • Fax: 407-324-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GRECO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 877-346-2211