Provider Demographics
NPI:1235857152
Name:PACIFICA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PACIFICA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-731-1010
Mailing Address - Street 1:1009 KAPIOLANI BLVD APT 4605
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2187
Mailing Address - Country:US
Mailing Address - Phone:203-731-1010
Mailing Address - Fax:
Practice Address - Street 1:30 E SAN JOAQUIN ST STE 203G
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2947
Practice Address - Country:US
Practice Address - Phone:203-731-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health