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NPI Code Detail

MEDICARE: UNIVERSITY OF THE PACIFIC

MEDICARE: UNIVERSITY OF THE PACIFIC
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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
190432OTHERCAOTHER, 90432 CA
290441OTHERCAOTHER 90441 CA

General Provider Information

NPI Number : 1932345386
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF THE PACIFIC
Provider Business Mailing Address
First Line : 3601 PACIFIC AVE
Second Line : UOP PSYCHOLOGY DEPARTMENT
City : STOCKTON
State : CA
Zip : 95211-0110
Country : US
Telephone Number : 209-946-2132
Fax Number : 209-946-2284
Provider Business Practice Location Address
First Line : 405 E PINE ST
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5522
Country : US
Telephone Number : 209-464-5519
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : HOLLY WHITE
Credential :
Telephone Number : 209-946-2132
Provider Enumeration Date : 01/06/2009
Last Update Date : 11/13/2019

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Directions to “UNIVERSITY OF THE PACIFIC ” Practice Location

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