Provider Demographics
NPI:1669925616
Name:PACIFIC CLINICS
Entity type:Organization
Organization Name:PACIFIC CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELIN
Authorized Official - Middle Name:ARIANA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-718-8594
Mailing Address - Street 1:11741 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3681
Mailing Address - Country:US
Mailing Address - Phone:626-294-1079
Mailing Address - Fax:
Practice Address - Street 1:11741 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3681
Practice Address - Country:US
Practice Address - Phone:626-294-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty