Provider Demographics
NPI:1316403512
Name:PASADENA NEUROPSYCHIATRY CENTER A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PASADENA NEUROPSYCHIATRY CENTER A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHATZMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-765-6704
Mailing Address - Street 1:595 E COLORADO BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2015
Mailing Address - Country:US
Mailing Address - Phone:626-765-6704
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 311
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2021
Practice Address - Country:US
Practice Address - Phone:626-765-6704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty