Healthcare Provider Details

I. General information

NPI: 1710132691
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY SUITE 220 & 240
LYNWOOD CA
90262-2663
US

IV. Provider business mailing address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-7174
  • Fax:
Mailing address:
  • Phone: 408-379-3790
  • Fax: 408-364-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN MCCARTHY
Title or Position: CHIEF EXECUTIVE OFFICER / PRESIDENT
Credential:
Phone: 408-379-3790