Provider Demographics
NPI:1447280722
Name:PACIFIC FAMILY HEALTH, INC.
Entity type:Organization
Organization Name:PACIFIC FAMILY HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:VASQUEZ
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:559-252-1932
Mailing Address - Street 1:3475 W SHAW AVE STE 102
Mailing Address - Street 2:3475 W SHAW AVE STE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3200
Mailing Address - Country:US
Mailing Address - Phone:559-252-1932
Mailing Address - Fax:559-456-3070
Practice Address - Street 1:3475 W SHAW AVE STE 102
Practice Address - Street 2:3475 W SHAW AVE STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3200
Practice Address - Country:US
Practice Address - Phone:559-252-1932
Practice Address - Fax:559-456-3070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC FAMILY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31922ZMedicare ID - Type Unspecified
CAA03434Medicare UPIN
CAA25968Medicare UPIN
CAA39103Medicare UPIN