Healthcare Provider Details

I. General information

NPI: 1952407629
Provider Name (Legal Business Name): PACIFIC AMERICAN MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5288 EASTGATE MALL
SAN DIEGO CA
92121-2835
US

IV. Provider business mailing address

5288 EASTGATE MALL
SAN DIEGO CA
92121-2835
US

V. Phone/Fax

Practice location:
  • Phone: 858-622-0792
  • Fax: 858-866-0760
Mailing address:
  • Phone: 858-622-0792
  • Fax: 858-866-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberRHF69929
License Number StateCA

VIII. Authorized Official

Name: MR. ROY ANTHONY BROWN
Title or Position: CEO
Credential: RT
Phone: 858-622-0792