Provider Demographics
NPI:1770801516
Name:PACIFIC WOMEN'S HEALTH CLINIC, INC
Entity type:Organization
Organization Name:PACIFIC WOMEN'S HEALTH CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:NITIN
Authorized Official - Last Name:MHAMUNKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-376-2496
Mailing Address - Street 1:2485 HOSPITAL DR STE 261
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4103
Mailing Address - Country:US
Mailing Address - Phone:877-376-2496
Mailing Address - Fax:888-650-6564
Practice Address - Street 1:2485 HOSPITAL DR STE 261
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4103
Practice Address - Country:US
Practice Address - Phone:877-376-2496
Practice Address - Fax:888-650-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105976261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty