Provider Demographics
NPI:1265854673
Name:PASADENA URGENT CARE, INC
Entity Type:Organization
Organization Name:PASADENA URGENT CARE, INC
Other - Org Name:ADVANCED URGENT CARE OF PASADENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SHOMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-304-0404
Mailing Address - Street 1:PO BOX 1075
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-5075
Mailing Address - Country:US
Mailing Address - Phone:626-304-0404
Mailing Address - Fax:626-304-0405
Practice Address - Street 1:797 S ARROYO PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3234
Practice Address - Country:US
Practice Address - Phone:626-304-0404
Practice Address - Fax:626-304-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95190261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB214392OtherMEDICARE PTAN
CACB213364OtherMEDICARE PTAN