Healthcare Provider Details

I. General information

NPI: 1710538095
Provider Name (Legal Business Name): DAREEN KHALAF PCP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N ALLEN AVE
PASADENA CA
91106-1601
US

IV. Provider business mailing address

215 N ALLEN AVE
PASADENA CA
91106-1601
US

V. Phone/Fax

Practice location:
  • Phone: 626-360-4579
  • Fax: 855-806-1554
Mailing address:
  • Phone: 626-360-4579
  • Fax: 855-806-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAREEN KHALAF
Title or Position: CEO
Credential: MD
Phone: 323-798-5158