Provider Demographics
NPI:1295569200
Name:PACIFIC COAST HEALTH MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PACIFIC COAST HEALTH MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-278-7545
Mailing Address - Street 1:1600 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6208
Mailing Address - Country:US
Mailing Address - Phone:949-278-7545
Mailing Address - Fax:
Practice Address - Street 1:1600 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6208
Practice Address - Country:US
Practice Address - Phone:949-278-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty