Provider Demographics
NPI:1740426980
Name:PACIFIC VIEW
Entity Type:Organization
Organization Name:PACIFIC VIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMINPUAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADUALT RESIDENTIAL
Authorized Official - Phone:310-521-9896
Mailing Address - Street 1:2300 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-5936
Mailing Address - Country:US
Mailing Address - Phone:310-521-9896
Mailing Address - Fax:
Practice Address - Street 1:2300 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-5936
Practice Address - Country:US
Practice Address - Phone:310-521-9896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198600662323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility