Provider Demographics
NPI:1700142940
Name:PACIFIC CLINICS
Entity Type:Organization
Organization Name:PACIFIC CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTREACH SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TASHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-466-8696
Mailing Address - Street 1:9047 ARROW RTE STE 170
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4434
Mailing Address - Country:US
Mailing Address - Phone:909-466-8696
Mailing Address - Fax:
Practice Address - Street 1:9047 ARROW RTE STE 170
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4434
Practice Address - Country:US
Practice Address - Phone:909-466-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health