Active NPI
Dylan Thomas Eilken
- Peer Specialist
- Pasadena, CA
National Provider Identifier
1265218762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- MPSS-GKTBSF
- Practice address
- 1230 N Marengo Ave
Pasadena, CA 91103-2217 - Phone
- (626) 797-1124
- NPI assigned
- Aug 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1523050823 | CA | |
| Peer Specialist | 175T00000X | MPSS-GKTBSF | CA | Primary |
Addresses
Primary practice location
1230 N Marengo Ave
Pasadena, CA 91103-2217
Mailing address
1230 N Marengo Ave
Pasadena, CA 91103-2217
Phone (626) 797-1124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1523050823 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| MPSS-GKTBSF | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1265218762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 N MARENGO AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911032217",
"telephone_number": "626-797-1124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1230 N MARENGO AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911032217",
"telephone_number": "626-797-1124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EILKEN",
"first_name": "DYLAN",
"middle_name": "THOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-31",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R1523050823",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-GKTBSF",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.