Healthcare Provider Details

I. General information

NPI: 1760720965
Provider Name (Legal Business Name): PACIFIC MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N WIGET LN STE 109
WALNUT CREEK CA
94598-2440
US

IV. Provider business mailing address

FILE 1616 1801 W OLYMPIC BLVD
PASADENA CA
91199-1616
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-9194
  • Fax: 925-935-9591
Mailing address:
  • Phone: 800-726-9180
  • Fax: 800-861-5950

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: GENERAL COUNSEL/C.O,.O.
Credential:
Phone: 800-726-9180