Healthcare Provider Details

I. General information

NPI: 1689321580
Provider Name (Legal Business Name): MR. RICK DALMACIO PASALO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000B S CENTER DR
CLEARLAKE CA
95422-8458
US

IV. Provider business mailing address

7000B S CENTER DR
CLEARLAKE CA
95422-8458
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-7090
  • Fax: 707-994-7164
Mailing address:
  • Phone: 707-703-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028903
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95210829
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95210829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: