Provider Demographics
NPI:1740446236
Name:KAISER PERMANENTE PANORAMA CITY MEDICAL CENTER
Entity type:Organization
Organization Name:KAISER PERMANENTE PANORAMA CITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN COMPENSATION-APC
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-375-2809
Mailing Address - Street 1:393 E. WALNUT ST
Mailing Address - Street 2:FL 3 -PHRS
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:626-405-7914
Mailing Address - Fax:
Practice Address - Street 1:393 E. WALNUT ST
Practice Address - Street 2:FL 3 -PHRS
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:626-405-7914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital