Healthcare Provider Details

I. General information

NPI: 1518283704
Provider Name (Legal Business Name): PACIFIC CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE
WESTMINSTER CALIFORNIA
92683
UM

IV. Provider business mailing address

13950 MILTON AVE
WESTMINSTER CA
92683
US

V. Phone/Fax

Practice location:
  • Phone: 714-901-4629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATY WELLS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 714-901-4629