Provider Demographics
NPI:1861636177
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 - ALHAMBRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRELLA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
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:626-794-2533
Practice Address - Street 1:320 S GARFIELD AVE STE 300
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3886
Practice Address - Country:US
Practice Address - Phone:626-798-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251V00000XAgenciesVoluntary or Charitable
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861636177Medicaid