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General NPI Number Information
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NPI Number | 1780309468
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 393 E WALNUT ST REGIONAL BEHAVIORAL HEALTH FL 2
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City | PASADENA
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State | CA
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Zip | 91188-0001
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Country | US
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Telephone | 877-608-0049
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Fax |
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Provider Business Mailing Address
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Address Line | 393 E WALNUT ST REGIONAL BEHAVIORAL HEALTH FL 2
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City | PASADENA
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State | CA
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Zip | 91188-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT REGIONAL MEDICAL DIRECTOR
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Name | DR. MARIA VILLAROSA
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Credential |
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Telephone | 951-809-5364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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