Healthcare Provider Details

I. General information

NPI: 1124912464
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 ROCK ST
MOUNTAIN VIEW CA
94043-1810
US

IV. Provider business mailing address

499 LOMA ALTA AVE
LOS GATOS CA
95030-6227
US

V. Phone/Fax

Practice location:
  • Phone: 650-903-6945
  • Fax:
Mailing address:
  • Phone: 408-379-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALMA ROMERO
Title or Position: DIRECTOR OF CREDENTIALING ADMIN
Credential:
Phone: 626-840-3207