Provider Demographics
NPI:1033221627
Name:PASADENA FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:PASADENA FAMILY MEDICINE INC
Other - Org Name:HUNTINGTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTENDING PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NALINI
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:MATTAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-792-1912
Mailing Address - Street 1:301 S FAIR OAKS AVE
Mailing Address - Street 2:STE #405
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2561
Mailing Address - Country:US
Mailing Address - Phone:626-792-1912
Mailing Address - Fax:626-792-1960
Practice Address - Street 1:301 S FAIR OAKS AVE
Practice Address - Street 2:STE #405
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2561
Practice Address - Country:US
Practice Address - Phone:626-792-1912
Practice Address - Fax:626-792-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83956208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty