Provider Demographics
NPI:1922105824
Name:UNIVERSITY OF THE PACIFIC
Entity Type:Organization
Organization Name:UNIVERSITY OF THE PACIFIC
Other - Org Name:PACIFIC HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EMR ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:209-946-2994
Mailing Address - Street 1:1041 BROOKSIDE RD COWELL WELLNESS CENTER
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95211-0110
Mailing Address - Country:US
Mailing Address - Phone:209-946-2315
Mailing Address - Fax:209-946-3001
Practice Address - Street 1:3601 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0110
Practice Address - Country:US
Practice Address - Phone:209-946-2315
Practice Address - Fax:209-946-3001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center