Healthcare Provider Details

I. General information

NPI: 1215845672
Provider Name (Legal Business Name): PACIFIC WELLNESS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520800 SAN JOSE VILLAGE
TINIAN MP
96952-0800
US

IV. Provider business mailing address

PO BOX 520800
TINIAN MP
96952-0800
US

V. Phone/Fax

Practice location:
  • Phone: 670-783-2468
  • Fax: 670-433-2664
Mailing address:
  • Phone: 670-783-2468
  • Fax: 670-433-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AURELIA G LONG
Title or Position: CLINICAL DIRECTOR
Credential: MSN,FNP,WHNP,CNLCP
Phone: 670-783-2468