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90 N Daisy Ave Pasadena CA 91107-3704 | |
| (626) 296-8900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 90 N Daisy Ave, Pasadena, California |
| Authorized Official Name and Position | Kim Blackmon (IBHIS DIRECTOR) |
| Authorized Official Contact | 6262968900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2750 E Washington Blvd Ste 230 Pasadena CA 91107-1449 Ph: (626) 296-8900 | 90 N Daisy Ave Pasadena CA 91107-3704 Ph: (626) 296-8900 |
| NPI Number | 1437707833 |
|---|---|
| Provider Enumeration Date | 08/28/2019 |
| Last Update Date | 02/04/2025 |
| Certification Date | 02/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437707833 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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