Provider Demographics
NPI:1831416734
Name:PASADENA PELLET THERAPY, INC.
Entity type:Organization
Organization Name:PASADENA PELLET THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-304-2626
Mailing Address - Street 1:625 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2613
Mailing Address - Country:US
Mailing Address - Phone:626-304-2626
Mailing Address - Fax:626-585-0695
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-304-2626
Practice Address - Fax:626-585-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-01
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty