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General NPI Number Information
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NPI Number | 1922105824
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF THE PACIFIC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 3601 PACIFIC AVE
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City | STOCKTON
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State | CA
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Zip | 95211-0110
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Country | US
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Telephone | 209-946-2315
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Fax | 209-946-3001
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Provider Business Mailing Address
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Address Line | 1041 BROOKSIDE RD COWELL WELLNESS CENTER
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City | STOCKTON
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State | CA
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Zip | 95211-0110
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Country | US
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Telephone | 209-946-2315
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Fax | 209-946-3001
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Authorized Official
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Title or Position | EMR ADMINISTRATOR
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Name | RANAI KOCH
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Credential | MBA
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Telephone | 209-946-2994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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