Healthcare Provider Details

I. General information

NPI: 1447360730
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S MYRTLE AVE
MONROVIA CA
91016-3427
US

IV. Provider business mailing address

800 S SANTA ANITA AVE
ARCADIA CA
91006-6853
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-3258
  • Fax: 626-301-0868
Mailing address:
  • Phone: 626-254-5000
  • Fax: 626-294-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES J. BALLA
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 626-254-5000