Provider Demographics
NPI:1720689540
Name:PACIFIC COAST HYDRATION INC
Entity Type:Organization
Organization Name:PACIFIC COAST HYDRATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALGENON
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-572-7375
Mailing Address - Street 1:75 TURNSTONE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1707
Mailing Address - Country:US
Mailing Address - Phone:404-668-2292
Mailing Address - Fax:
Practice Address - Street 1:4630 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1822
Practice Address - Country:US
Practice Address - Phone:949-572-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty