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General NPI Number Information
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NPI Number | 1467467357
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Entity Type | Organization
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Legal Business Name | PACIFICA PAIN MANAGEMENT SERVICES
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 1700 SOSCOL AVE SUITE 25
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City | NAPA
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State | CA
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Zip | 94559-1351
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Country | US
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Telephone | 707-963-1493
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Fax | 707-963-1463
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Provider Business Mailing Address
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Address Line | 1700 SOSCOL AVE SUITE 25
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City | NAPA
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State | CA
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Zip | 94559-1351
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Country | US
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Telephone | 707-963-1493
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Fax | 707-963-1463
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GARY K. MILLS
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Credential | PH.D.
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Telephone | 707-963-1493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 280015AP
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License Number State | CA
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