Healthcare Provider Details

I. General information

NPI: 1285567867
Provider Name (Legal Business Name): BENEDICT PAGCALIWANGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S LAKE AVE STE 205
PASADENA CA
91101-5054
US

IV. Provider business mailing address

3315 W HELLMAN AVE
ALHAMBRA CA
91803-2556
US

V. Phone/Fax

Practice location:
  • Phone: 626-240-1060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number90268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: