Provider Demographics
NPI:1326288317
Name:PACIFIC MEDICAL RESOURCES, INC.
Entity Type:Organization
Organization Name:PACIFIC MEDICAL RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-964-2000
Mailing Address - Street 1:1102 S MAIN ST # 3
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5305
Mailing Address - Country:US
Mailing Address - Phone:707-964-2000
Mailing Address - Fax:
Practice Address - Street 1:1102 S MAIN ST # 3
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5305
Practice Address - Country:US
Practice Address - Phone:707-964-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000339251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care