Healthcare Provider Details

I. General information

NPI: 1730825803
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 S LAND PARK DR STE 103
SACRAMENTO CA
95831-3661
US

IV. Provider business mailing address

499 LOMA ALTA AVE
LOS GATOS CA
95030-6227
US

V. Phone/Fax

Practice location:
  • Phone: 916-388-6400
  • Fax:
Mailing address:
  • Phone: 408-379-3790
  • Fax: 408-364-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GORDON RICHARDSON
Title or Position: SENIOR VP, CLINICAL ADMINISTRATION
Credential:
Phone: 916-388-6301