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General NPI Number Information
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NPI Number | 1831563600
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Entity Type | Organization
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Legal Business Name | PACIFICA MEDICINE
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 07/27/2024
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Provider Practice Location Address
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Address Line | 19036 FRONT ST NE # 100
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City | POULSBO
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State | WA
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Zip | 98370-7354
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Country | US
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Telephone | 360-979-0569
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Fax | 877-805-9505
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Provider Business Mailing Address
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Address Line | PO BOX 2940
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City | POULSBO
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State | WA
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Zip | 98370-2940
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Country | US
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Telephone | 360-297-8805
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Fax | 360-297-1676
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIE MATTY
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Credential | MD
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Telephone | 360-297-8805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | WA
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