Healthcare Provider Details

I. General information

NPI: 1255370797
Provider Name (Legal Business Name): GIANCARLO PASQUALE DIMASSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S MADISON AVE
PASADENA CA
91106-4404
US

IV. Provider business mailing address

817 S MADISON AVE
PASADENA CA
91106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 310-753-0885
  • Fax: 626-696-3210
Mailing address:
  • Phone: 310-753-0885
  • Fax: 626-696-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA81063
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA81063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: