Provider Demographics
NPI:1164811691
Name:SAN MARINO PSYCHIATRIC HOSPITALISTS, INC
Entity Type:Organization
Organization Name:SAN MARINO PSYCHIATRIC HOSPITALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PYLKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-403-8999
Mailing Address - Street 1:2400 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1632
Mailing Address - Country:US
Mailing Address - Phone:626-403-8999
Mailing Address - Fax:626-403-8989
Practice Address - Street 1:2400 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1632
Practice Address - Country:US
Practice Address - Phone:626-403-8999
Practice Address - Fax:626-403-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital