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General NPI Number Information
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NPI Number | 1013435213
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Entity Type | Organization
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Legal Business Name | PACIFIC CLINCS
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 9353 VALLEY BLVD
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City | ROSEMEAD
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State | CA
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Zip | 91770-1934
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Country | US
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Telephone | 626-287-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 11693 FOREST GROVE ST
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City | EL MONTE
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State | CA
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Zip | 91732-2221
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Country | US
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Telephone | 626-215-3762
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH WORKER
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Name | JOSEPHINE TRAN
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Credential |
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Telephone | 626-215-3762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | APFC-OP-12-013-007
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License Number State | CA
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