Provider Demographics
NPI:1033501077
Name:PACIFIC PRIVATE PRACTICE NETWORK INC
Entity Type:Organization
Organization Name:PACIFIC PRIVATE PRACTICE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROVZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-291-6521
Mailing Address - Street 1:30230 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1557
Mailing Address - Country:US
Mailing Address - Phone:949-441-5681
Mailing Address - Fax:949-629-3716
Practice Address - Street 1:30230 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1557
Practice Address - Country:US
Practice Address - Phone:949-441-5681
Practice Address - Fax:949-629-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty