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General NPI Number Information
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NPI Number | 1316403512
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Entity Type | Organization
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Legal Business Name | PASADENA NEUROPSYCHIATRY CENTER A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 595 E COLORADO BLVD STE 311
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City | PASADENA
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State | CA
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Zip | 91101-2021
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Country | US
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Telephone | 626-765-6704
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Fax |
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Provider Business Mailing Address
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Address Line | 595 E COLORADO BLVD STE 602
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City | PASADENA
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State | CA
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Zip | 91101-2015
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Country | US
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Telephone | 626-765-6704
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RON ANDREW SHATZMILLER
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Credential | MD
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Telephone | 626-765-6704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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