Healthcare Provider Details

I. General information

NPI: 1023632791
Provider Name (Legal Business Name): OSCAR BACH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N MADISON AVE
PASADENA CA
91101-1710
US

IV. Provider business mailing address

11224 DANBURY ST
ARCADIA CA
91006-5609
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-8102
  • Fax:
Mailing address:
  • Phone: 626-366-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: