Provider Demographics
NPI:1073669040
Name:PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-794-5737
Mailing Address - Street 1:2333 LAKE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2463
Mailing Address - Country:US
Mailing Address - Phone:626-794-5737
Mailing Address - Fax:626-794-2533
Practice Address - Street 1:1045 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4521
Practice Address - Country:US
Practice Address - Phone:626-794-5737
Practice Address - Fax:626-794-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000134251V00000X, 291U00000X
261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251V00000XAgenciesVoluntary or Charitable
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA960000134OtherCOMMUNITY CLINIC
CA1073669040Medicaid