Basic Information
| Provider Information | |||||||||
| NPI: | 1740446236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAISER PERMANENTE PANORAMA CITY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E. WALNUT ST | ||||||||
| Address2: | FL 3 -PHRS | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264057914 | ||||||||
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| Practice Location | |||||||||
| Address1: | 393 E. WALNUT ST | ||||||||
| Address2: | FL 3 -PHRS | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264057914 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOUDAKIAN | ||||||||
| AuthorizedOfficialFirstName: | JEANINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN COMPENSATION-APC | ||||||||
| AuthorizedOfficialTelephone: | 8183752809 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.