Healthcare Provider Details

I. General information

NPI: 1487855086
Provider Name (Legal Business Name): PASADENA GASTROENTEROLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD STE 330
PASADENA CA
91107-1448
US

IV. Provider business mailing address

2750 E. WASHINGTON BLVD STE 330
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-9883
  • Fax:
Mailing address:
  • Phone: 626-797-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: BEA THOMAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-797-9883