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General NPI Number Information
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NPI Number | 1578808200
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH ALLIANCE OF PASADENA
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 10408 VACCO ST SUITE A
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City | SOUTH EL MONTE
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State | CA
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Zip | 91733-3328
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Country | US
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Telephone | 626-486-9640
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Fax | 626-486-9654
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Provider Business Mailing Address
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Address Line | 455 W MONTANA ST
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City | PASADENA
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State | CA
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Zip | 91103-1327
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Country | US
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Telephone | 626-993-1212
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Fax | 626-993-1288
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. MARGARET BANDA MARTINEZ
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Credential | MPH
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Telephone | 626-993-1227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 550002384
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License Number State | CA
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