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General NPI Number Information
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NPI Number | 1336247642
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Entity Type | Organization
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Legal Business Name | PASADENA ENDOSCOPY CENTER INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 55 W VALLEY ST
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City | PASADENA
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State | CA
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Zip | 91105-2015
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Country | US
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Telephone | 626-793-9900
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Fax | 626-793-9944
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Provider Business Mailing Address
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Address Line | 55 W VALLEY ST
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City | PASADENA
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State | CA
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Zip | 91105-2015
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Country | US
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Telephone | 626-793-9900
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Fax | 626-793-9944
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. RICHARD NICKOWITZ
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Credential | MD
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Telephone | 626-793-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 930000974
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License Number State | CA
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