Provider Demographics
NPI:1205862752
Name:PACIFIC ARTHRITIS CARE CENTER INC.
Entity Type:Organization
Organization Name:PACIFIC ARTHRITIS CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-297-9221
Mailing Address - Street 1:5230 PACIFIC CONCOURSE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6200
Mailing Address - Country:US
Mailing Address - Phone:310-297-9221
Mailing Address - Fax:310-297-9222
Practice Address - Street 1:5230 PACIFIC CONCOURSE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6200
Practice Address - Country:US
Practice Address - Phone:310-297-9221
Practice Address - Fax:310-297-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098100Medicaid
CAGR0098100Medicaid