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General NPI Number Information
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NPI Number | 1336542927
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST PHYSICIANS GROUP, INC.
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 15720 VENTURA BLVD STE 400
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City | ENCINO
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State | CA
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Zip | 91436-2911
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Country | US
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Telephone | 818-986-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 15720 VENTURA BLVD STE 400
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City | ENCINO
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State | CA
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Zip | 91436-2911
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Country | US
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Telephone |
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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 | MR. JONATHAN YAKER
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Credential |
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Telephone | 818-986-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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