Healthcare Provider Details

I. General information

NPI: 1245723071
Provider Name (Legal Business Name): PACIFIC ASSOCIATES MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LAKEWOOD BLVD STE 103
DOWNEY CA
90240-4039
US

IV. Provider business mailing address

9900 LAKEWOOD BLVD STE 103
DOWNEY CA
90240-4039
US

V. Phone/Fax

Practice location:
  • Phone: 562-387-0403
  • Fax: 562-396-0403
Mailing address:
  • Phone: 562-387-0403
  • Fax: 562-396-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: RICHARD GOLDSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 951-313-9530