Individual
EDGARDO MENVIELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 E DEL MAR BLVD STE 126, PASADENA, CA 91105-2551
(626) 569-8074
(626) 423-6678
Mailing address
200 E DEL MAR BLVD, PASADENA, CA 91105-2544
(626) 569-8074
(626) 423-6678
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C43180
CA
2084P0804X
Child & Adolescent Psychiatry Physician
C43180
CA
Other
Enumeration date
10/03/2006
Last updated
01/25/2021
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