1043346364 NPI number — PACIFIC CLINICS

Table of content: MARJORIE LAIRD LMFT, LPC, CACIII (NPI 1497243513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043346364 NPI number — PACIFIC CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043346364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S SANTA ANITA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCADIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91006-6853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-254-5000
Provider Business Mailing Address Fax Number:
626-294-1077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58945 BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
SUITE D & E
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-9657
Provider Business Practice Location Address Fax Number:
760-369-6758
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALLA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
626-254-5000

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36BB , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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