Healthcare Provider Details

I. General information

NPI: 1720689540
Provider Name (Legal Business Name): PACIFIC COAST HYDRATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20951 BROOKHURST ST STE 107
HUNTINGTON BEACH CA
92646-6648
US

IV. Provider business mailing address

110 BELLATRIX
IRVINE CA
92618-1727
US

V. Phone/Fax

Practice location:
  • Phone: 949-469-0675
  • Fax:
Mailing address:
  • Phone: 404-668-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALGENON M PARSON
Title or Position: PRESIDENT
Credential: MD
Phone: 949-572-7375