Provider Demographics
NPI:1962497214
Name:PACIFIC THERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:PACIFIC THERAPEUTIC SERVICES INC
Other - Org Name:PACIFIC THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-922-2776
Mailing Address - Street 1:23232 PERALTA DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1443
Mailing Address - Country:US
Mailing Address - Phone:949-922-2776
Mailing Address - Fax:949-497-3499
Practice Address - Street 1:23232 PERALTA DR
Practice Address - Street 2:SUITE 113
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1443
Practice Address - Country:US
Practice Address - Phone:949-922-2776
Practice Address - Fax:949-497-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18569Medicare ID - Type Unspecified