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General NPI Number Information
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NPI Number | 1508840232
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Entity Type | Organization
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Legal Business Name | PASADENA COLON & RECTAL MED GRP
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 65 N MADISON AVE STE 410
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City | PASADENA
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State | CA
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Zip | 91101-2035
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Country | US
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Telephone | 626-795-4261
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Fax | 626-795-1506
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Provider Business Mailing Address
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Address Line | 65 N MADISON AVE STE 410
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City | PASADENA
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State | CA
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Zip | 91101-2035
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Country | US
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Telephone | 626-795-4261
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Fax | 626-795-1506
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. LUIS WM MARTINEZ
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Credential | MD
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Telephone | 626-795-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A029395
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License Number State | CA
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