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General NPI Number Information
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NPI Number | 1821481722
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST MEDICAL CLINIC
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 3067 MOORPARK AVE SUITE 100
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City | SAN JOSE
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State | CA
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Zip | 95128
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Country | US
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Telephone | 408-438-2248
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Fax | 408-244-7248
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Provider Business Mailing Address
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Address Line | 3067 MOORPARK AVE SUITE 100
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City | SAN JOSE
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State | CA
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Zip | 95128
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Country | US
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Telephone | 408-438-2248
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Fax | 408-244-7248
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AFSOUN SUE PANAHI
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Credential |
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Telephone | 408-438-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 32345
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | ND-588
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 20A9504
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License Number State | CA
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