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General NPI Number Information
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NPI Number | 1407434004
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Entity Type | Individual
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Provider Name | RAMON TIBAY PACINA JR. NP
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Gender | Male
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 23018 MONETA AVE
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City | CARSON
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State | CA
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Zip | 90745-4732
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Country | US
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Telephone | 310-830-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 1819 WASHINGTON AVE APT A
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City | SANTA MONICA
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State | CA
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Zip | 90403-3324
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Country | US
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Telephone | 818-934-7833
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Fax | 562-786-8613
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95017039
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License Number State | CA
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