Provider Demographics
NPI:1235160995
Name:PASEO MEDICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:PASEO MEDICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAMRAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-978-6100
Mailing Address - Street 1:13606 N 59TH AVE
Mailing Address - Street 2:# 1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1271
Mailing Address - Country:US
Mailing Address - Phone:602-978-6100
Mailing Address - Fax:602-978-2446
Practice Address - Street 1:13606 N 59TH AVE
Practice Address - Street 2:# 1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1271
Practice Address - Country:US
Practice Address - Phone:602-978-6100
Practice Address - Fax:602-978-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23394207R00000X
AZ21668207RP1001X
AZ28048207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60525Medicare ID - Type Unspecified