Provider Demographics
NPI:1205371630
Name:PACIFIC TRAUMA ASSOCIATES, INC
Entity type:Organization
Organization Name:PACIFIC TRAUMA ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-941-5059
Mailing Address - Street 1:35 E GLENARM ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3418
Mailing Address - Country:US
Mailing Address - Phone:626-768-4415
Mailing Address - Fax:626-403-0321
Practice Address - Street 1:11550 INDIAN HILLS RD STE 310
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1203
Practice Address - Country:US
Practice Address - Phone:818-898-4900
Practice Address - Fax:818-898-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA906382086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90638OtherCA MED LICENSE