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General NPI Number Information
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NPI Number | 1871754432
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST ALLERGY
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1585 S RAILROAD AVE
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City | CRESCENT CITY
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State | CA
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Zip | 95531-6821
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Country | US
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Telephone | 707-464-3430
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Fax | 707-464-4668
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Provider Business Mailing Address
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Address Line | 1585 S RAILROAD AVE
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City | CRESCENT CITY
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State | CA
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Zip | 95531-6821
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Country | US
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Telephone | 707-464-3430
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Fax | 707-464-4668
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT CERTIFIED
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Name | MS. ELISE K. WILLIAMS
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Credential | PA-C
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Telephone | 707-464-3430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | PA14562
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License Number State | CA
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