Healthcare Provider Details

I. General information

NPI: 1629874847
Provider Name (Legal Business Name): PACIFICO ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SCHILLINGER RD N STE 102
MOBILE AL
36608-5060
US

IV. Provider business mailing address

30 SCHILLINGER RD N STE 102
MOBILE AL
36608-5060
US

V. Phone/Fax

Practice location:
  • Phone: 251-388-9055
  • Fax:
Mailing address:
  • Phone: 251-388-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: NIA MASEY
Title or Position: COO
Credential:
Phone: 251-388-9055