Pacific Cddc
Clinic/Center, Medical Specialty in Costa Mesa, CA. Organization (NPI-2).
NPI number1861936601
StatusActive
Last updated in NPPESDec 13, 2016
Details
- NPI
- 1861936601
- Entity type
- Organization (NPI-2)
- Legal business name
- Pacific Cddc
- Organization subpart
- Yes
- Enumeration date
- Dec 13, 2016
- Last updated
- Dec 13, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2500X | Clinic/Center, Medical Specialty | – | – | Yes |
Practice location
1640 Newport BlvdSuite 350
Costa Mesa, CA 92627-3786
Phone 949-386-5260 · Fax 949-515-0031
Mailing address
Po Box 54708Los Angeles, CA 90054-0708
Phone 714-456-3856 · Fax 714-456-8101
Authorized official
Manuel Porto
President
7144562986
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