Provider Demographics
NPI:1093830036
Name:PACIFIC CLINICS
Entity type:Organization
Organization Name:PACIFIC CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-254-5000
Mailing Address - Street 1:800 S SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6853
Mailing Address - Country:US
Mailing Address - Phone:626-254-5000
Mailing Address - Fax:626-294-1077
Practice Address - Street 1:66 HURLBUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4025
Practice Address - Country:US
Practice Address - Phone:626-332-1367
Practice Address - Fax:626-332-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7462Medicaid
CAW279Medicare PIN