Healthcare Provider Details

I. General information

NPI: 1275384133
Provider Name (Legal Business Name): EXPATIATE COMMUNITY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MARENGO AVE STE 202
PASADENA CA
91101-1503
US

IV. Provider business mailing address

215 N MARENGO AVE STE 202
PASADENA CA
91101-1503
US

V. Phone/Fax

Practice location:
  • Phone: 844-387-5836
  • Fax:
Mailing address:
  • Phone: 844-387-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ARJUN KUSHWAHA
Title or Position: DIRECTOR
Credential: MS
Phone: 844-387-5836