Healthcare Provider Details

I. General information

NPI: 1699220145
Provider Name (Legal Business Name): PCH PASADENA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MISSION ST
SAN MARINO CA
91108-1632
US

IV. Provider business mailing address

11965 VENICE BLVD STE 202
LOS ANGELES CA
90066-3954
US

V. Phone/Fax

Practice location:
  • Phone: 310-566-7625
  • Fax:
Mailing address:
  • Phone: 310-566-7625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY KREKORIAN
Title or Position: PRESIDENT
Credential:
Phone: 310-963-2059