Healthcare Provider Details

I. General information

NPI: 1851538326
Provider Name (Legal Business Name): PASADENA ENDOCRINOLOGY, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E WALNUT ST SUITE 115
PASADENA CA
91101-1585
US

IV. Provider business mailing address

221 E WALNUT ST SUITE 115
PASADENA CA
91101-1585
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-0505
  • Fax: 626-577-5959
Mailing address:
  • Phone: 626-577-0505
  • Fax: 626-577-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG72900
License Number StateCA

VIII. Authorized Official

Name: DR. DOROTHEA ELISABETH SPAMBALG
Title or Position: OWNER
Credential: M.D.
Phone: 626-577-0505