Healthcare Provider Details

I. General information

NPI: 1609011394
Provider Name (Legal Business Name): PAC LAP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST THIRD FLOOR
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

2250 HAYES ST THIRD FLOOR
SAN FRANCISCO CA
94117-1078
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-3200
  • Fax: 415-668-2010
Mailing address:
  • Phone: 415-668-3200
  • Fax: 415-668-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG51241
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA17826
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN M RABKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 415-668-3200