Provider Demographics
NPI:1093815052
Name:LIFE FITNESS CENTER A MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LIFE FITNESS CENTER A MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSED
Authorized Official - Phone:626-578-7111
Mailing Address - Street 1:200 E DEL MAR BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2544
Mailing Address - Country:US
Mailing Address - Phone:626-578-7111
Mailing Address - Fax:626-578-7161
Practice Address - Street 1:200 E DEL MAR BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2544
Practice Address - Country:US
Practice Address - Phone:626-578-7111
Practice Address - Fax:626-578-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty