MEDICARE: DR. EDMUND O PASCUAL MD

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	208000000X	Pediatrics Physician	A42651	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ32579Z	OTHER	CA	CHDP

General Provider Information

NPI Number	:	1306895412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUND O PASCUAL MD

Provider Business Mailing Address
First Line	:	1500 W WEST COVINA PKWY
Second Line	:	SUITE 201
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2703
Country	:	US
Telephone Number	:	626-263-7020
Fax Number	:	626-960-9177

Provider Business Practice Location Address
First Line	:	777 FLOWER ST STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-3000
Country	:	US
Telephone Number	:	818-637-2000
Fax Number	:	818-242-8761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/14/2011

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