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General NPI Number Information
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NPI Number | 1487881397
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Entity Type | Organization
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Legal Business Name | PACIFICA HEALTH SERVICES LLC
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 4911 SW 19TH ST
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City | DES MOINES
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State | IA
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Zip | 50315-4487
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Country | US
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Telephone | 515-285-2559
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Fax | 515-285-6487
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Provider Business Mailing Address
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Address Line | 4911 SW 19TH ST
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City | DES MOINES
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State | IA
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Zip | 50315-4487
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Country | US
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Telephone | 515-285-2559
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Fax | 515-285-6487
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Authorized Official
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Title or Position | OWNER
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Name | ALLEN PHILIP WOLNERMAN
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Credential | RPH, FASCP
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Telephone | 515-285-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 770692
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 770692
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 770692
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License Number State | IA
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