Healthcare Provider Details

I. General information

NPI: 1366203002
Provider Name (Legal Business Name): PACIFICA EAST LAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 E BOBIER DRIVE
VISTA CA
92084
US

IV. Provider business mailing address

760 E BOBIER DR
VISTA CA
92084-3806
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-1480
  • Fax: 760-941-5981
Mailing address:
  • Phone: 760-941-1480
  • Fax: 760-941-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DEEPAK ISRANI
Title or Position: GENERAL MANAGER
Credential:
Phone: 619-296-9000