Healthcare Provider Details

I. General information

NPI: 1255345203
Provider Name (Legal Business Name): PATRICK MICHAEL MULLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 210
PASADENA CA
91105-4005
US

IV. Provider business mailing address

50 ALESSANDRO PL STE 210
PASADENA CA
91105-4005
US

V. Phone/Fax

Practice location:
  • Phone: 626-514-0060
  • Fax: 626-514-0062
Mailing address:
  • Phone: 626-514-0060
  • Fax: 626-514-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA62503
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA62503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: