Healthcare Provider Details

I. General information

NPI: 1225230246
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 W GARVEY AVE N
WEST COVINA CA
91790-2138
US

IV. Provider business mailing address

1517 W GARVEY AVE N
WEST COVINA CA
91790-2138
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-6061
  • Fax: 626-962-4471
Mailing address:
  • Phone: 626-962-6061
  • Fax: 626-962-4471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN SU
Title or Position: PROGRAM DIRECTOR
Credential: ASW
Phone: 626-962-6061