Provider Demographics
NPI:1265640197
Name:PACIFIC CLINICS
Entity Type:Organization
Organization Name:PACIFIC CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ON SITE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHAVEZ
Authorized Official - Last Name:JR
Authorized Official - Suffix:
Authorized Official - Credentials:AADEGREE
Authorized Official - Phone:805-276-5917
Mailing Address - Street 1:460 LAS PALOMAS DR.
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:805-889-6135
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-276-5917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management