1497094114 NPI number — PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC

Table of content: (NPI 1497094114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497094114 NPI number — PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497094114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 N LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-794-5737
Provider Business Mailing Address Fax Number:
626-390-9948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W ROUTE 66
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-6249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-644-7926
Provider Business Practice Location Address Fax Number:
626-644-7935
Provider Enumeration Date:
02/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ESHLEMAN
Authorized Official First Name:
BETHANY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PATIENT SERVICES
Authorized Official Telephone Number:
626-794-5737

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  960000134 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497094114 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 550002371 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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