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General NPI Number Information
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NPI Number | 1104117647
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Entity Type | Organization
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Legal Business Name | PACIFIC HEALING AND WELLNESS, INC.
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 5242 KATELLA AVE SUITE 106
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2820
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Country | US
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Telephone | 949-214-8559
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Fax |
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Provider Business Mailing Address
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Address Line | 5242 KATELLA AVE SUITE 106
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2820
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Country | US
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Telephone | 949-214-8559
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SANDRA L GOINES
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Credential | D.O.
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Telephone | 949-214-8559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2OA8212
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License Number State | CA
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