Basic Information
| Provider Information | |||||||||
| NPI: | 1043341332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASH | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11110 LOS ALAMITOS BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907203602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148331569 | ||||||||
| FaxNumber: | 5629812622 | ||||||||
| Practice Location | |||||||||
| Address1: | 11110 LOS ALAMITOS BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907203602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148331569 | ||||||||
| FaxNumber: | 5629812622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 41774 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.