Provider Demographics
NPI:1770303414
Name:ARCHIVE HEALTH MEDICAL PC
Entity type:Organization
Organization Name:ARCHIVE HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA-PECINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-421-1915
Mailing Address - Street 1:712 H ST NE STE 47
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3627
Mailing Address - Country:US
Mailing Address - Phone:216-245-5259
Mailing Address - Fax:
Practice Address - Street 1:2701 KEYSTONE PACIFIC PKWY
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8872
Practice Address - Country:US
Practice Address - Phone:216-245-5259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty