Healthcare Provider Details

I. General information

NPI: 1306253687
Provider Name (Legal Business Name): PACIFIC ACCOUNTABLE CARE NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST SUITE 425
BURBANK CA
91505-4569
US

IV. Provider business mailing address

201 S BUENA VISTA ST SUITE 425
BURBANK CA
91505-4569
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-8311
  • Fax: 818-953-9366
Mailing address:
  • Phone: 818-848-8311
  • Fax: 818-953-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIPPE JEAN QUILICI
Title or Position: CEO
Credential: MD
Phone: 818-848-8311