Healthcare Provider Details

I. General information

NPI: 1205369006
Provider Name (Legal Business Name): PASADENA INFECTIOUS DISEASES AND TROPICAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL SUITE 360
PASADENA CA
91105-3149
US

IV. Provider business mailing address

50 ALESSANDRO PL SUITE 360
PASADENA CA
91105-3149
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-6133
  • Fax: 626-793-6135
Mailing address:
  • Phone: 626-793-6133
  • Fax: 626-793-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA43877
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY A SHRINER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-793-6133