Healthcare Provider Details

I. General information

NPI: 1417183336
Provider Name (Legal Business Name): MADISON 101 PASADENA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST SUITE 101
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST SUITE 101
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-5134
  • Fax: 626-793-2912
Mailing address:
  • Phone: 626-793-5134
  • Fax: 626-793-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10275
License Number StateCA

VIII. Authorized Official

Name: MICHAEL S SCHWARTZ
Title or Position: OWNER
Credential: MD
Phone: 626-793-5134