| Persona Neuro Behavior Group Inc. | |
|
625 Fair Oaks Avenue Suite 390 South Pasadena CA 91030 | |
| (626) 449-2484 | |
| (626) 449-1107 |
| Full Name | Persona Neuro Behavior Group Inc. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 625 Fair Oaks Avenue, South Pasadena, California |
| Authorized Official Name and Position | Marcel O. Ponton (PRESIDENT) |
| Authorized Official Contact | 6264492484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Persona Neuro Behavior Group Inc. 625 Fair Oaks Ave Suite 390 South Pasadena CA 91030-2630 Ph: (626) 449-2484 | Persona Neuro Behavior Group Inc. 625 Fair Oaks Avenue Suite 390 South Pasadena CA 91030 Ph: (626) 449-2484 |
| NPI Number | 1881798171 |
|---|---|
| Provider Enumeration Date | 09/08/2006 |
| Last Update Date | 07/21/2015 |
| Medicare PECOS PAC ID | 7416847413 |
|---|---|
| Medicare Enrollment ID | O20040315001627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881798171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PSY12133 (California) | Primary |
| Provider Name | Teresita Morales |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912005034 PECOS PAC ID: 2466431143 Enrollment ID: I20040715001446 |
| Provider Name | Marcel O Ponton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861595845 PECOS PAC ID: 8224928221 Enrollment ID: I20051019000596 |
| Provider Name | Lori Williams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255632535 PECOS PAC ID: 2365624426 Enrollment ID: I20110310000311 |
| Provider Name | Diomaris Safi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790063410 PECOS PAC ID: 6002129434 Enrollment ID: I20150714002684 |
| Provider Name | Heleya Rad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629395546 PECOS PAC ID: 0446540108 Enrollment ID: I20160608001425 |
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