Provider Demographics
NPI:1740251594
Name:PACIFICA ORTHOPEDICS
Entity type:Organization
Organization Name:PACIFICA ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO,FAA ,OOS
Authorized Official - Phone:714-841-5333
Mailing Address - Street 1:18800 DELAWARE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1959
Mailing Address - Country:US
Mailing Address - Phone:714-841-5333
Mailing Address - Fax:714-841-5303
Practice Address - Street 1:18800 DELAWARE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1959
Practice Address - Country:US
Practice Address - Phone:714-841-5333
Practice Address - Fax:714-841-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19041111NX0800X
CA20A4964204C00000X
CA20A4685204C00000X
CA20A4153204C00000X
CAA70813204C00000X
CA17911204C00000X
CAA29528204C00000X
CA20A8191204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17911OtherSTATE LIC#
CA20A4685OtherSTATE LIC#
CA20A4964OtherSTATE LIC#
CA20A8191OtherSTATE LIC#
CAZZZ05885ZOtherBLUE SHIELD ID
CAA29528OtherSTATE LIC#
CA20A4153OtherSTATE LIC#
CAA93571Medicare UPIN
CAW15879Medicare ID - Type Unspecified
CA20A4964OtherSTATE LIC#
CAA67757Medicare UPIN
CA20A4685OtherSTATE LIC#
CAW20A4564BMedicare ID - Type Unspecified