MEDICARE: COMMUNITY HEALTH ALLIANCE OF PASADENA

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1477924520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH ALLIANCE OF PASADENA

Provider Business Mailing Address
First Line	:	455 W MONTANA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1327
Country	:	US
Telephone Number	:	626-993-1238
Fax Number	:	626-993-1288

Provider Business Practice Location Address
First Line	:	3703 PECK RD
Second Line	:	SUITE A - C
City	:	EL MONTE
State	:	CA
Zip	:	91731-3543
Country	:	US
Telephone Number	:	626-993-1238
Fax Number	:	626-993-1288

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. MARGARET BANDA MARTINEZ
Credential	:	MPH
Telephone Number	:	626-993-1227

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	04/18/2017

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