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General NPI Number Information
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NPI Number | 1689418915
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Entity Type | Organization
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Legal Business Name | PACIFICA CLINICS
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1302 N 4TH ST
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City | SAN JOSE
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State | CA
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Zip | 95112-4713
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Country | US
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Telephone | 626-254-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 N 4TH ST
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City | SAN JOSE
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State | CA
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Zip | 95112-4713
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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 | ABA BEHAVIOR TECHNICIAN
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Name | SARAH WHITESIDE
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Credential | RBT
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Telephone | 669-302-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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