Basic Information
| Provider Information | |||||||||
| NPI: | 1275657314 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC CLINICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 S ARROYO PKWY | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264034888 | ||||||||
| FaxNumber: | 6264034894 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 WALL ST | ||||||||
| Address2: | E215 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900142314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136890295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | MANDEL | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 6262545000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 225400000X | CA | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.