Healthcare Provider Details

I. General information

NPI: 1962497214
Provider Name (Legal Business Name): PACIFIC THERAPEUTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23232 PERALTA DR SUITE 113
LAGUNA HILLS CA
92653-1443
US

IV. Provider business mailing address

23232 PERALTA DR SUITE 113
LAGUNA HILLS CA
92653-1443
US

V. Phone/Fax

Practice location:
  • Phone: 949-922-2776
  • Fax: 949-497-3499
Mailing address:
  • Phone: 949-922-2776
  • Fax: 949-497-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name: THAD BROWN
Title or Position: PRESIDENT/SECRETARY
Credential:
Phone: 949-922-2776