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General NPI Number Information
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NPI Number | 1629239892
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Entity Type | Individual
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Provider Name | JACKLIN POLADIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 800 SOUTH FAIRMOUNT AVE. SUITE 420
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City | PASADENA
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State | CA
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Zip | 91105-3154
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Country | US
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Telephone | 626-200-4500
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Fax | 626-795-0704
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Provider Business Mailing Address
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Address Line | 800 SOUTH FAIRMOUNT AVE. SUITE 420
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City | PASADENA
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State | CA
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Zip | 91105-3154
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Country | US
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Telephone | 626-200-4500
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Fax | 626-795-0704
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A110327
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License Number State | CA
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