Healthcare Provider Details

I. General information

NPI: 1053602250
Provider Name (Legal Business Name): VALERIE P. MYERS, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST #400
PASADENA CA
91105-3045
US

IV. Provider business mailing address

10 CONGRESS ST #400
PASADENA CA
91105-3045
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-6223
  • Fax: 626-449-0035
Mailing address:
  • Phone: 626-449-6223
  • Fax: 626-449-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG52632
License Number StateCA

VIII. Authorized Official

Name: LINDA CARNOW
Title or Position: BILLER
Credential:
Phone: 626-449-6223