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General NPI Number Information
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NPI Number | 1033500087
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Entity Type | Organization
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Legal Business Name | PACIFIC MEDICAL AND WELLNESS GROUP INC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 3300 IRVINE AVE SUITE 307
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-724-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 IRVINE AVE SUITE 307
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-724-1800
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARY EBERHART
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Credential | DC
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Telephone | 949-724-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC26382
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A64951
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License Number State | CA
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