Healthcare Provider Details

I. General information

NPI: 1962584904
Provider Name (Legal Business Name): PASADENA NEPHROLOGY CORPORATION A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S FAIR OAKS AVE
PASADENA CA
91105-2601
US

IV. Provider business mailing address

PO BOX 1390
SOUTH PASADENA CA
91031-1390
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-1675
  • Fax: 626-577-9115
Mailing address:
  • Phone: 626-577-1675
  • Fax: 626-577-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S LINSEY
Title or Position: PARTNER
Credential: M.D.
Phone: 626-577-1675