Healthcare Provider Details

I. General information

NPI: 1003602350
Provider Name (Legal Business Name): PACIFICA INFUSION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38660 MEDICAL CENTER DR STE A130
PALMDALE CA
93551-4385
US

IV. Provider business mailing address

38660 MEDICAL CENTER DR STE A130
PALMDALE CA
93551-4385
US

V. Phone/Fax

Practice location:
  • Phone: 661-506-1861
  • Fax: 661-506-1771
Mailing address:
  • Phone: 661-506-1861
  • Fax: 661-506-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN WILLIAMS
Title or Position: OWNER
Credential:
Phone: 424-234-9329