Healthcare Provider Details

I. General information

NPI: 1255991485
Provider Name (Legal Business Name): COMMUNITY HEALTH ALLIANCE OF PASADENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 N FAIR OAKS AVE STE 100
PASADENA CA
91103-1620
US

IV. Provider business mailing address

455 W MONTANA ST
PASADENA CA
91103-1327
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-1238
  • Fax:
Mailing address:
  • Phone: 626-993-1238
  • Fax: 626-993-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA CHAVEZ
Title or Position: BUSINESS OPERATIONS MANAGER
Credential:
Phone: 626-993-1238