Provider Demographics
NPI:1508840232
Name:PASADENA COLON & RECTAL MED GRP
Entity Type:Organization
Organization Name:PASADENA COLON & RECTAL MED GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:WM
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-4261
Mailing Address - Street 1:65 N MADISON AVE
Mailing Address - Street 2:STE 410
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2035
Mailing Address - Country:US
Mailing Address - Phone:626-795-4261
Mailing Address - Fax:626-795-1506
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:STE 410
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2035
Practice Address - Country:US
Practice Address - Phone:626-795-4261
Practice Address - Fax:626-795-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA029395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29395Medicare UPIN
CAW1295Medicare PIN
CAWA29395AMedicare PIN