Basic Information
| Provider Information | |||||||||
| NPI: | 1285940056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC HOUSECALLS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 TULLY RD | ||||||||
| Address2: | SUITE C8A | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953500838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095248700 | ||||||||
| FaxNumber: | 2098467518 | ||||||||
| Practice Location | |||||||||
| Address1: | 3340 TULLY RD | ||||||||
| Address2: | SUITE C8A | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953500838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095248700 | ||||||||
| FaxNumber: | 2098467518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | O'SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2095248700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.