Provider Demographics
NPI:1598960130
Name:FOOS PSYCHIATRIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FOOS PSYCHIATRIC MEDICAL GROUP INC
Other - Org Name:DAVID C FOOS MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-449-2874
Mailing Address - Street 1:2810 EAST DEL MAR BLVD
Mailing Address - Street 2:SUITE 11B
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-449-2874
Mailing Address - Fax:626-449-4907
Practice Address - Street 1:2810 EAST DEL MAR BLVD
Practice Address - Street 2:SUITE 11B
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-449-2874
Practice Address - Fax:626-449-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG321872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherBLUE CROSS BLUE SHIELD
CAW11133Medicare ID - Type Unspecified
=========OtherBLUE CROSS BLUE SHIELD