Healthcare Provider Details

I. General information

NPI: 1467604041
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE 306
WESTMINSTER CA
92683-2900
US

IV. Provider business mailing address

800 S SANTA ANITA AVE
ARCADIA CA
91006-6853
US

V. Phone/Fax

Practice location:
  • Phone: 714-379-4484
  • Fax: 714-379-5009
Mailing address:
  • Phone: 626-254-5000
  • Fax: 626-294-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN MANDEL
Title or Position: PRESIDENT/CEO
Credential: PH.D.
Phone: 626-254-5000