Healthcare Provider Details

I. General information

NPI: 1801512223
Provider Name (Legal Business Name): PACIFIC NATURAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 E 18TH AVE
EUGENE OR
97401-4360
US

IV. Provider business mailing address

951 W 27TH AVE
EUGENE OR
97405-2230
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-9658
  • Fax:
Mailing address:
  • Phone: 925-705-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICOLE FARRA NOCETO
Title or Position: MEMBER
Credential: L.AC., DACM
Phone: 925-705-0826