Provider Demographics
NPI:1497094114
Name:PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC
Other - Org Name:PLANNED PARENTHOOD PASADENA - GLENDORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:626-794-5737
Mailing Address - Street 1:2333 LAKE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2463
Mailing Address - Country:US
Mailing Address - Phone:626-794-5737
Mailing Address - Fax:626-390-9948
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-644-7926
Practice Address - Fax:626-644-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000134251V00000X
261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497094114Medicaid