Provider Demographics
NPI:1760745517
Name:PACIFIC WOMEN'S HEALTHCARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PACIFIC WOMEN'S HEALTHCARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NINO
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-760-9316
Mailing Address - Street 1:500 SUPERIOR AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-760-9316
Mailing Address - Fax:949-760-5438
Practice Address - Street 1:500 SUPERIOR AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-760-9316
Practice Address - Fax:949-760-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty