=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740426980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFIC VIEW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2008
-----------------------------------------------------
Last Update Date | 12/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 S PACIFIC AVE
-----------------------------------------------------
City | SAN PEDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90731-5936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-521-9896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 S PACIFIC AVE
-----------------------------------------------------
City | SAN PEDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90731-5936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-521-9896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FACILITY MANAGER
-----------------------------------------------------
Name | MRS. YOLANDA PAMINPUAN
-----------------------------------------------------
Credential | ADUALT RESIDENTIAL
-----------------------------------------------------
Telephone | 310-521-9896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number | 198600662
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------