Provider Demographics
NPI:1629543046
Name:PACIFIC PEDIATRICS, LLC
Entity Type:Organization
Organization Name:PACIFIC PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-300-8189
Mailing Address - Street 1:PO BOX 1732
Mailing Address - Street 2:
Mailing Address - City:WARD COVE
Mailing Address - State:AK
Mailing Address - Zip Code:99928-1732
Mailing Address - Country:US
Mailing Address - Phone:313-300-8189
Mailing Address - Fax:907-225-8189
Practice Address - Street 1:63 HIGGINS SPUR
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-9442
Practice Address - Country:US
Practice Address - Phone:313-300-8189
Practice Address - Fax:907-225-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty