Healthcare Provider Details

I. General information

NPI: 1336333418
Provider Name (Legal Business Name): PACIFIC MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 VIA CARTAMA
SAN CLEMENTE CA
92673-6998
US

IV. Provider business mailing address

2652 MOUNTAIN VIEW DR
ESCONDIDO CA
92027-4933
US

V. Phone/Fax

Practice location:
  • Phone: 888-277-2957
  • Fax: 888-277-2957
Mailing address:
  • Phone: 760-294-8527
  • Fax: 888-277-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID E FARLOW
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 760-294-8527