Healthcare Provider Details

I. General information

NPI: 1457600488
Provider Name (Legal Business Name): PACIFICA EMERGENCY MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16237 VENTURA BLVD
ENCINO CA
91436-2201
US

IV. Provider business mailing address

POST OFFICE BOX 660520
ARCADIA CA
91066-0520
US

V. Phone/Fax

Practice location:
  • Phone: 818-995-5351
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRV EDWARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-379-2134