Provider Demographics
NPI:1407406630
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:<UNAVAIL>
Other - Org Type:
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 1:620 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1220
Mailing Address - Country:US
Mailing Address - Phone:626-794-5737
Mailing Address - Fax:626-794-2533
Practice Address - Street 1:5903 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:CA
Practice Address - Zip Code:90042-4229
Practice Address - Country:US
Practice Address - Phone:626-794-5737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANNED PARENTHOOD PASADENA AND SAN GABRIEL VALLEY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407406630Medicaid
CA550006140OtherLICENSE