Healthcare Provider Details

I. General information

NPI: 1376015966
Provider Name (Legal Business Name): PACIFIC GARDENS MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

700 17TH ST STE 201D
MODESTO CA
95354-1249
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-0401
  • Fax: 562-924-5871
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY JEAN THOMPSON
Title or Position: EXECUTIVE VICE PRESIDENT, CFO
Credential:
Phone: 209-287-6308