Provider Demographics
NPI:1609074806
Name:PACIFIC GYNECOLOGIC SPECIALISTS
Entity Type:Organization
Organization Name:PACIFIC GYNECOLOGIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-847-4436
Mailing Address - Street 1:P.O, BOX 8410
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-8410
Mailing Address - Country:US
Mailing Address - Phone:818-847-4436
Mailing Address - Fax:818-847-4432
Practice Address - Street 1:181 SOUTH BUENA VISTA STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1204
Practice Address - Country:US
Practice Address - Phone:818-847-4436
Practice Address - Fax:818-847-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0103810207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103810Medicaid
CAW19545Medicare PIN