Healthcare Provider Details

I. General information

NPI: 1669778544
Provider Name (Legal Business Name): PACIFIC CLINICS' ORANGE WELLNESS AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W ORANGEWOOD AVE
ORANGE CA
92868-2040
US

IV. Provider business mailing address

1717 W ORANGEWOOD AVE
ORANGE CA
92868-2040
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-8340
  • Fax:
Mailing address:
  • Phone: 714-712-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number225400000X
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN DAVID BYRNE
Title or Position: MENTAL HEALTH WORKER
Credential:
Phone: 562-293-8312