MEDICARE: PASADENA FAMILY MEDICINE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G83956	CA

General Provider Information

NPI Number	:	1033221627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASADENA FAMILY MEDICINE INC

Provider Business Mailing Address
First Line	:	301 S FAIR OAKS AVE
Second Line	:	STE #405
City	:	PASADENA
State	:	CA
Zip	:	91105-2561
Country	:	US
Telephone Number	:	626-792-1912
Fax Number	:	626-792-1960

Provider Business Practice Location Address
First Line	:	301 S FAIR OAKS AVE
Second Line	:	STE #405
City	:	PASADENA
State	:	CA
Zip	:	91105-2561
Country	:	US
Telephone Number	:	626-792-1912
Fax Number	:	626-792-1960

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN OWNER
Name	:	DR. NALINI DEVI MATTAI
Credential	:	MD
Telephone Number	:	626-792-1912

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/12/2012

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