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General NPI Number Information
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NPI Number | 1437406683
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Entity Type | Organization
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Legal Business Name | CENTURY PACIFIC MEDICAL, INC.
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 115 GAUGUIN CIR
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3878
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Country | US
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Telephone | 800-239-4119
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Fax | 866-528-9127
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Provider Business Mailing Address
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Address Line | PO BOX 1419
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City | LAKE FOREST
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State | CA
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Zip | 92609-1419
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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 | OWNER
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Name | VICTOR NODTVEDT
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Credential |
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Telephone | 949-360-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | CA
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