Provider Demographics
NPI:1649496845
Name:PACIFIC DIAGNOSTIC
Entity type:Organization
Organization Name:PACIFIC DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-321-5425
Mailing Address - Street 1:14482 BEACH BLVD STE T
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5341
Mailing Address - Country:US
Mailing Address - Phone:714-321-5425
Mailing Address - Fax:714-892-4942
Practice Address - Street 1:14482 BEACH BLVD STE T
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5341
Practice Address - Country:US
Practice Address - Phone:714-321-5425
Practice Address - Fax:714-892-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory