MEDICARE: PACIFIC COLLLEGE OF ORIENTAL MEDICINE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1134383573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC COLLLEGE OF ORIENTAL MEDICINE, INC

Provider Business Mailing Address
First Line	:	7445 MISSION VALLEY RD
Second Line	:	SUITE 105
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4408
Country	:	US
Telephone Number	:	619-574-6909
Fax Number	:	619-574-1639

Provider Business Practice Location Address
First Line	:	7445 MISSION VALLEY RD
Second Line	:	SUITE 105
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4408
Country	:	US
Telephone Number	:	619-574-6909
Fax Number	:	619-574-1639

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN MILLER II
Credential	:
Telephone Number	:	619-574-6909

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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