Healthcare Provider Details

I. General information

NPI: 1205241452
Provider Name (Legal Business Name): PACIFIC LIFE LINES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
PALO ALTO CA
94305-2200
US

IV. Provider business mailing address

PO BOX 27573
SAN FRANCISCO CA
94127-0573
US

V. Phone/Fax

Practice location:
  • Phone: 520-907-5367
  • Fax:
Mailing address:
  • Phone: 520-907-5367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberD02481240
License Number StateCA

VIII. Authorized Official

Name: BRIANNA MICHELLE YANEZ
Title or Position: PERFUSIONIST
Credential: M.S.
Phone: 520-907-5367