Healthcare Provider Details

I. General information

NPI: 1659794097
Provider Name (Legal Business Name): PACIFIC MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD SUITE 400
COSTA MESA CA
92627-3786
US

IV. Provider business mailing address

PO BOX 54509
LOS ANGELES CA
90054-0509
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-2400
  • Fax: 949-999-2405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALPESH AMIN
Title or Position: DEPT CHAIR
Credential: MD
Phone: 714-456-2986