Provider Demographics
NPI:1164615910
Name:PACIFIC PSYCHIATRY INC.
Entity Type:Organization
Organization Name:PACIFIC PSYCHIATRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RIVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-541-5055
Mailing Address - Street 1:3220 S HIGUERA ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6987
Mailing Address - Country:US
Mailing Address - Phone:805-541-5055
Mailing Address - Fax:805-541-5075
Practice Address - Street 1:3220 S HIGUERA ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6987
Practice Address - Country:US
Practice Address - Phone:805-541-5055
Practice Address - Fax:805-541-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27547482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC2754748OtherCORP RESGISTRATION #
CAFNP33987OtherFICITITOUS NAME PERMIT