Healthcare Provider Details

I. General information

NPI: 1184407470
Provider Name (Legal Business Name): CYRINE MARI PHAN-MADRONA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

IV. Provider business mailing address

2652 MAYNARD DR
DUARTE CA
91010-2215
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax: 714-276-2604
Mailing address:
  • Phone:
  • Fax: 714-276-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: