Provider Demographics
NPI:1457301632
Name:PACIFIC EAST HEALTHCARE, INC
Entity type:Organization
Organization Name:PACIFIC EAST HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-558-0886
Mailing Address - Street 1:10104 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3510
Mailing Address - Country:US
Mailing Address - Phone:510-558-0886
Mailing Address - Fax:510-558-8504
Practice Address - Street 1:10104 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3510
Practice Address - Country:US
Practice Address - Phone:510-558-0886
Practice Address - Fax:510-558-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41883261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care