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General NPI Number Information
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NPI Number | 1003891516
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Entity Type | Organization
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Legal Business Name | PACIFICA LINDA MAR INC.
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 751 SAN PEDRO TERRACE RD
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City | PACIFICA
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State | CA
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Zip | 94044-4101
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Country | US
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Telephone | 650-359-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 25910 ACERO STE 350
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City | MISSION VIEJO
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State | CA
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Zip | 92691-7908
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Country | US
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Telephone | 949-441-9258
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARC JOHNSON
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Credential |
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Telephone | 949-373-8373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 220000095
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License Number State | CA
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