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General NPI Number Information
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NPI Number | 1740860360
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Entity Type | Organization
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Legal Business Name | PACIFIC CONSULTING GROUP, LLC.
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 477 MORNING CANYON RD
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2614
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Country | US
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Telephone | 949-200-9649
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Fax |
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Provider Business Mailing Address
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Address Line | 477 MORNING CANYON RD
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2614
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Country | US
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Telephone | 949-200-9649
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOE WOOTEN
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Credential |
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Telephone | 714-396-1902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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