Healthcare Provider Details

I. General information

NPI: 1134736705
Provider Name (Legal Business Name): SERAPHIM STEM CELL RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 256-348-5521
  • Fax: 626-449-2759
Mailing address:
  • Phone: 626-449-1944
  • Fax: 626-449-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLADWIN GILL
Title or Position: CEO
Credential: PH. D
Phone: 818-262-5900