Healthcare Provider Details

I. General information

NPI: 1437095767
Provider Name (Legal Business Name): PACIFIC MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W ROBINHOOD DR STE L
STOCKTON CA
95207-5626
US

IV. Provider business mailing address

1700 N CHRISMAN RD
TRACY CA
95304-9314
US

V. Phone/Fax

Practice location:
  • Phone: 209-490-4515
  • Fax: 209-227-8522
Mailing address:
  • Phone: 800-726-9180
  • Fax: 209-221-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARK WEAVER
Title or Position: CLO
Credential:
Phone: 800-723-9180