MEDICARE: PACIFIC CLINICS

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750424321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC CLINICS

Provider Business Mailing Address
First Line	:	800 S SANTA ANITA AVE
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-6853
Country	:	US
Telephone Number	:	626-254-5000
Fax Number	:	626-294-1077

Provider Business Practice Location Address
First Line	:	1460 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2300
Country	:	US
Telephone Number	:	626-296-7710
Fax Number	:	626-296-7714

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	JAMES J. BALLA
Credential	:
Telephone Number	:	626-254-5000

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/17/2021

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Directions to “PACIFIC CLINICS ” Practice Location

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