Provider Demographics
NPI:1043341332
Name:PASH, JEFFREY A
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:PASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 LOS ALAMITOS BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3602
Mailing Address - Country:US
Mailing Address - Phone:714-833-1569
Mailing Address - Fax:562-981-2622
Practice Address - Street 1:11110 LOS ALAMITOS BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3602
Practice Address - Country:US
Practice Address - Phone:714-833-1569
Practice Address - Fax:562-981-2622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist