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General NPI Number Information
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NPI Number | 1538497813
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Entity Type | Organization
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Legal Business Name | PACIFICA HEALTH & WELLNESS CLINIC, INC.
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 5524 MISSION BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92509-4515
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Country | US
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Telephone | 951-248-9113
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Fax | 951-248-9115
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Provider Business Mailing Address
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Address Line | 5524 MISSION BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92509-4515
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Country | US
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Telephone | 951-248-9113
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Fax | 951-248-9115
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | DR. STEVE THUAN VU
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Credential | M.D.
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Telephone | 714-393-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A64785
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA16671
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10031
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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