Healthcare Provider Details

I. General information

NPI: 1487957288
Provider Name (Legal Business Name): COMMUNITY HEALTH ALLIANCE OF PASADENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

1855 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-6300
  • Fax: 626-398-5948
Mailing address:
  • Phone: 626-398-6300
  • Fax: 626-398-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARET MARTINEZ
Title or Position: CEO
Credential: CEO
Phone: 626-398-6300