Healthcare Provider Details

I. General information

NPI: 1700963790
Provider Name (Legal Business Name): PACIFICA OF THE VALLEY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 SAN FERNANDO ROAD
SUN VALLEY CA
91352
US

IV. Provider business mailing address

9449 SAN FERNANDO ROAD
SUN VALLEY CA
91352
US

V. Phone/Fax

Practice location:
  • Phone: 818-767-3310
  • Fax: 818-252-2291
Mailing address:
  • Phone: 818-767-3310
  • Fax: 818-252-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHSP42138
License Number StateCA

VIII. Authorized Official

Name: MR. GEORGE WATKINS
Title or Position: CFO
Credential:
Phone: 818-252-2196