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General NPI Number Information
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NPI Number | 1215845672
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Entity Type | Organization
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Legal Business Name | PACIFIC WELLNESS NETWORK INC
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 520800 SAN JOSE VILLAGE
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City | TINIAN
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State | MP
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Zip | 96952-0800
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Country | US
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Telephone | 670-783-2468
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Fax | 670-433-2664
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Provider Business Mailing Address
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Address Line | PO BOX 520800
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City | TINIAN
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State | MP
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Zip | 96952-0800
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Country | US
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Telephone | 670-783-2468
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Fax | 670-433-2664
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. AURELIA G LONG
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Credential | MSN,FNP,WHNP,CNLCP
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Telephone | 670-783-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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