NPIMap

Organization Active NPI

Persona Neuro Behavior Group Inc.

  • Clinical Neuropsychologist
  • South Pasadena, CA
National Provider Identifier
1881798171
Registry record updated Jul 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY12133 Issued in CA
Legal business name
PERSONA NEURO BEHAVIOR GROUP INC.
Practice address
625 Fair Oaks Avenue
Suite 390
South Pasadena, CA 91030
Phone
(626) 449-2484
Fax
(626) 449-1107
NPI assigned
Sep 8, 2006
Last updated
Jul 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marcel O. Ponton, PH.D.
Title
President
Phone
(626) 449-2484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X PSY12133 CA Primary

Addresses

Primary practice location

625 Fair Oaks Avenue
Suite 390
South Pasadena, CA 91030

Mailing address

625 Fair Oaks Ave
Suite 390
South Pasadena, CA 91030-2630
Phone (626) 449-2484

National Provider Directory

National Provider Directory

Locations

2010 N Fine Ave
Ste 102
Fresno, CA 93727
Phone (800) 314-7273

2307 N Fine Ave
Ste 108
Fresno, CA 93727
Phone (626) 449-2484

595 E Colorado Blvd
Ste 800
Pasadena, CA 91101
Phone (626) 449-2484

1818 N Orange Grove Ave
Pomona, CA 91767
Phone (909) 622-8791

625 Fair Oaks Ave
Ste 390
South Pasadena, CA 91030
Phone (626) 449-2484

2522 Chambers Rd
#211D
Tustin, CA 92780
Phone (626) 449-2484

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1881798171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 FAIR OAKS AVE",
            "address_2": "SUITE 390",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910302630",
            "telephone_number": "626-449-2484",
            "fax_number": "626-449-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 FAIR OAKS AVENUE",
            "address_2": "SUITE 390",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "91030",
            "telephone_number": "626-449-2484",
            "fax_number": "626-449-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONA NEURO BEHAVIOR GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "PONTON",
        "authorized_official_first_name": "MARCEL",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-449-2484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY12133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.