Healthcare Provider Details

I. General information

NPI: 1558423418
Provider Name (Legal Business Name): PACIFICA ORTHOPEDICS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 DELAWARE ST SUITE 1100
HUNTINGTON BEACH CA
92648-1959
US

IV. Provider business mailing address

18800 DELEWARE ST SUITE 1100
HUNTINGTON BEACH CA
92648
US

V. Phone/Fax

Practice location:
  • Phone: 714-841-5333
  • Fax: 714-369-2083
Mailing address:
  • Phone: 714-841-5333
  • Fax: 714-841-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number19041
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA94520
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA70813
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A8191
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT17708
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A4964
License Number StateCA

VIII. Authorized Official

Name: DR. EMILE PAUL WAKIM
Title or Position: PRESIDENT
Credential: MD
Phone: 714-841-5333