| Life Fitness Center A Medical Group Inc | |
|
200 E Del Mar Blvd Suite 208 Pasadena CA 91105-2544 | |
| (626) 578-7111 | |
| (626) 578-7161 |
| Full Name | Life Fitness Center A Medical Group Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 200 E Del Mar Blvd, Pasadena, California |
| Authorized Official Name and Position | Daniel M Asimus (CEO) |
| Authorized Official Contact | 6265787111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Fitness Center A Medical Group Inc 200 E Del Mar Blvd Suite 208 Pasadena CA 91105-2544 Ph: (626) 578-7111 | Life Fitness Center A Medical Group Inc 200 E Del Mar Blvd Suite 208 Pasadena CA 91105-2544 Ph: (626) 578-7111 |
| NPI Number | 1093815052 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 06/30/2009 |
| Medicare PECOS PAC ID | 8224927348 |
|---|---|
| Medicare Enrollment ID | O20090701000314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093815052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jane E Mathews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376632471 PECOS PAC ID: 7113110925 Enrollment ID: I20101025000404 |
| Provider Name | Cheri A Ewing |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083775431 PECOS PAC ID: 6507891447 Enrollment ID: I20150226000766 |
| Provider Name | Roberto Zarate |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790811248 PECOS PAC ID: 6204145089 Enrollment ID: I20151016002256 |
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