Basic Information
| Provider Information | |||||||||
| NPI: | 1801005764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC CLINICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 RUSSELL CT | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926174000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494134335 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11721 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428316 | ||||||||
| FaxNumber: | 5629493642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CASTELLANO | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | JANAE | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH WORKER III | ||||||||
| AuthorizedOfficialTelephone: | 5629428316 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.