Healthcare Provider Details

I. General information

NPI: 1316403512
Provider Name (Legal Business Name): PASADENA NEUROPSYCHIATRY CENTER A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 311
PASADENA CA
91101-2021
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 602
PASADENA CA
91101-2015
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-6704
  • Fax:
Mailing address:
  • Phone: 626-765-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RON ANDREW SHATZMILLER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 626-765-6704