SOUTH LAKE MEDICAL CENTER INC (NPI# 1295092021) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295092021 |
| Entity Type | Organization |
| Organization Name | SOUTH LAKE MEDICAL CENTER INC |
| Practice Address |
350 S Lake Ave Ste 280 Pasadena CA 91101-3530 |
| Mailing Address |
2980 N Beverly Glen Cir Suite 301 Los Angeles CA 90077-1726 |
| Practice Telephone | 6264498314 |
| Mailing Telephone | 3104749809 |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |
| Authorized Official Name | DR. HAROLD V. MITZELFELT (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6264498314 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTH LAKE MEDICAL CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144414038 | South Lake Medical Center Inc | Internal Medicine | 1950 Hospital View Way, Clermont, FL 34711-1926 | 2007-09-04 |
| Street Address |
350 S LAKE AVE STE 280 |
| City | PASADENA |
| State | CA |
| Zip Code | 91101-3530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235224569 | Richard Alec Schofield | Marriage & Family Therapist | 350 S Lake Ave, Suite 284d, Pasadena, CA 91101-3530 | 2006-10-03 |
| 1992179626 | Joseph Anthony Aldana | Chiropractor | 350 S Lake Ave, Ste 220, Pasadena, CA 91101-3579 | 2015-11-18 |
| 1003257296 | Katherine Marie Flores | Marriage & Family Therapist | 350 S Lake Ave, Suite 284b, Pasadena, CA 91101-3530 | 2013-07-16 |
| 1003189895 | Joseph Charles Gonzales Ordona | Chiropractor | 350 S Lake Ave, Suite 280, Pasadena, CA 91101-3530 | 2012-02-10 |
| 1194027748 | Diamond Vision Optometry, Inc | Optometrist | 350 S Lake Ave, #111, Pasadena, CA 91101-3530 | 2010-12-01 |
| 1487808374 | Jacqueline Wu | Optometrist | 350 S Lake Ave, Suite 111, Pasadena, CA 91101-3530 | 2008-11-05 |
| 1275789000 | Wilbur Wu | Optometrist | 350 S Lake Ave, Suite 111, Pasadena, CA 91101-3530 | 2008-08-12 |
| 1538389952 | James M. Labriola | Dentist | 350 S Lake Ave, Suite 250, Pasadena, CA 91101-3530 | 2007-04-26 |
| 1891836839 | Collins Chiropractic Professional Corp | Chiropractor | 350 S Lake Ave, Suite 230, Pasadena, CA 91101-3530 | 2007-02-11 |
| 1861539074 | E. Wayne Collins | Chiropractor | 350 S Lake Ave, Suite 230, Pasadena, CA 91101-3530 | 2007-01-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720696404 | Sophia Ting-jan Liang | Student in an Organized Health Care Education/Training Program | 98 S. Los Robles Ave., Kaiser Permanente Bernard J. Tyson School of Medicine, Pasdena, CA 91101 | 2020-07-17 |
| 1851917033 | Casa De Las Amigas | Lodging | 173 N Oak Knoll Ave, Pasadena, CA 91101 | 2020-06-23 |
| 1467076869 | Tong Qi | Student in an Organized Health Care Education/Training Program | Kaiser Permanente Bernard Kj. Tyson School of Medicine, Pasadena, CA 91101 | 2020-06-01 |
| 1386267839 | Kelly B Shriver | Student in an Organized Health Care Education/Training Program | Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles, Pasadena, CA 91101 | 2020-05-19 |
| 1427600758 | Brooke Danielle Pechman | Marriage & Family Therapist | 221 E Walnut Street, Suite 138, Pasadena, CA 91101 | 2019-07-16 |
| 1952897563 | Robert Howes Hambleton | Dentist | 200 S. Oak Knoll Ave #201, Pasadena, CA 91101 | 2018-07-06 |
| 1801306774 | Joseph Hendrix | Social Worker | 1500 South Mcdonnell Avenue, Commerce, CA 91101 | 2017-10-05 |
| 1730606070 | Candice Anne Watson | Nurse Practitioner | 350 South Madison Ave #322, Pasadena, CA 91101 | 2017-08-28 |
| 1700320223 | Jenny H. Pak | Psychologist | 180 N. Oakland Ave., Pasadena, CA 91101 | 2016-12-19 |
| 1578005401 | James Maddox | Student in an Organized Health Care Education/Training Program | 447 El Molino Ave, Pasadena, CA 91101 | 2016-11-09 |
| Find all providers in zip 91101 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1609927185 | Chad E Sullivan | Non-Pharmacy Dispensing Site | 4104 Yellowstone Dr, Pasadena, TX 77504-3427 | 2007-01-13 |
| 1295819837 | Above (b2) | Non-Pharmacy Dispensing Site | 8125 H Ritchie Highway, Pasadena, MD 21122-6925 | 2006-10-24 |
| 1306263645 | Amg- A Professional Medical Corporation | Non-Pharmacy Dispensing Site | 193 E Orange Grove Blvd, Pasadena, CA 91103-3487 | 2014-03-25 |
| 1952741019 | Ms-hc, LLC | Non-Pharmacy Dispensing Site | 8028 Ritchie Hwy, Suite 207, Pasadena, MD 21122-1075 | 2013-07-03 |
| 1770840605 | Welman T. Lim, Dpm, Inc | Non-Pharmacy Dispensing Site | 131 N El Molino Ave, Suite 230, Pasadena, CA 91101-1873 | 2012-04-17 |
| 1346488962 | Ronald Rigor Md Inc | Non-Pharmacy Dispensing Site | 675 S Arroyo Pkwy, Suite 100-b, Pasadena, CA 91105-3263 | 2009-02-04 |
| 1902948839 | Health Care Partners, Inc. | Non-Pharmacy Dispensing Site | 988 S Fair Oaks Ave, Pasadena, CA 91105-2626 | 2007-02-14 |
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| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
| 1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.