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General NPI Number Information
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NPI Number | 1366389801
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Entity Type | Organization
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Legal Business Name | PACIFICA HEALTH MEDICAL GROUP PC
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90027-6098
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Country | US
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Telephone | 323-913-4300
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Fax | 800-309-4918
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Provider Business Mailing Address
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Address Line | 1300 N VERMONT AVE STE 407
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City | LOS ANGELES
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State | CA
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Zip | 90027-6086
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Country | US
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Telephone | 323-913-4524
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Fax | 800-245-0408
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM THOMAS LONG
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Credential | MD
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Telephone | 323-913-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine 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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology 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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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