Provider Demographics
NPI:1851763882
Name:PES-EBS.INC.
Entity Type:Organization
Organization Name:PES-EBS.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-888-1010
Mailing Address - Street 1:600 W SANTA ANA BLVD
Mailing Address - Street 2:SUITES 107, 108, 109, & 110
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5458
Mailing Address - Country:US
Mailing Address - Phone:714-667-7926
Mailing Address - Fax:530-888-9065
Practice Address - Street 1:600 W SANTA ANA BLVD
Practice Address - Street 2:SUITES 107, 108, 109, & 110
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5458
Practice Address - Country:US
Practice Address - Phone:714-667-7926
Practice Address - Fax:530-888-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608733251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8048OtherDRUG MEDI-CAL