Provider Demographics
NPI:1629481312
Name:PACORPNATION
Entity Type:Organization
Organization Name:PACORPNATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-920-2873
Mailing Address - Street 1:901 S HARBOR BLVD APT 223
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2371
Mailing Address - Country:US
Mailing Address - Phone:559-920-2873
Mailing Address - Fax:
Practice Address - Street 1:12665 GARDEN GROVE BLVD STE 713
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1921
Practice Address - Country:US
Practice Address - Phone:714-537-7500
Practice Address - Fax:714-537-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21762363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty