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General NPI Number Information
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NPI Number | 1164762092
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Entity Type | Organization
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Legal Business Name | PACIFIC CLINICS
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 2144 MIDVALE AVE.
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-902-2863
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Fax |
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Provider Business Mailing Address
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Address Line | 2144 MIDVALE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-5708
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Country | US
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Telephone | 310-902-2863
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | WENLI JEN
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Credential | ED.D
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Telephone | 626-287-2988
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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 | 171M00000X
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License Number State | CA
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