Provider Demographics
NPI:1558423418
Name:PACIFICA ORTHOPEDICS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFICA ORTHOPEDICS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-841-5333
Mailing Address - Street 1:18800 DELEWARE ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-841-5333
Mailing Address - Fax:714-841-5303
Practice Address - Street 1:18800 DELAWARE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1959
Practice Address - Country:US
Practice Address - Phone:714-841-5333
Practice Address - Fax:714-369-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19041111NR0400X
CAA94520207X00000X
CA20A4964207X00000X
CAA70813207XS0117X
CA20A81912081S0010X
CAPT177082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty