Healthcare Provider Details

I. General information

NPI: 1538497813
Provider Name (Legal Business Name): PACIFICA HEALTH & WELLNESS CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 MISSION BLVD
RIVERSIDE CA
92509-4515
US

IV. Provider business mailing address

5524 MISSION BLVD
RIVERSIDE CA
92509-4515
US

V. Phone/Fax

Practice location:
  • Phone: 951-248-9113
  • Fax: 951-248-9115
Mailing address:
  • Phone: 951-248-9113
  • Fax: 951-248-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA64785
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16671
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10031
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVE THUAN VU
Title or Position: OWNER/ MEDICAL DIRECTOR
Credential: M.D.
Phone: 714-393-5800