MEDICARE: PACIFIC HEALTH SOLUTIONS, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609029974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HEALTH SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	541 10TH ST NW # 124
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5713
Country	:	US
Telephone Number	:	404-454-6136
Fax Number	:	404-393-0685

Provider Business Practice Location Address
First Line	:	541 10TH ST NW # 124
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5713
Country	:	US
Telephone Number	:	404-454-6136
Fax Number	:	404-393-0685

Authorized Official
Title or Position	:	CEO
Name	:	ALBERTO ESTEVEZ
Credential	:
Telephone Number	:	404-454-6136

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	11/13/2008

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