Provider Demographics
NPI:1205369006
Name:PASADENA INFECTIOUS DISEASES AND TROPICAL MEDICINE INC
Entity Type:Organization
Organization Name:PASADENA INFECTIOUS DISEASES AND TROPICAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHRINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-793-6133
Mailing Address - Street 1:50 ALESSANDRO PL
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3149
Mailing Address - Country:US
Mailing Address - Phone:626-793-6133
Mailing Address - Fax:626-793-6135
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 360
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-793-6133
Practice Address - Fax:626-793-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43877207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003926882OtherRENDERING NPI