Healthcare Provider Details

I. General information

NPI: 1215063532
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S RIVERSIDE AVE
RIALTO CA
92376-7725
US

IV. Provider business mailing address

800 S SANTA ANITA AVE
ARCADIA CA
91006-6853
US

V. Phone/Fax

Practice location:
  • Phone: 909-877-4889
  • Fax: 909-877-4898
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: DR. SUSAN MANDEL
Title or Position: PRESIDENT CEO
Credential: PHD
Phone: 626-254-5000