1124557996 NPI number — PACIFIC COAST NATUROPATHIC HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124557996 NPI number — PACIFIC COAST NATUROPATHIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC COAST NATUROPATHIC HEALTH
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:
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:
1124557996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24581 HARBOR VIEW DR UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-1750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-416-4670
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2007 S COAST HWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92651-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-416-4670
Provider Business Practice Location Address Fax Number:
949-416-4670
Provider Enumeration Date:
06/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PULNIK
Authorized Official First Name:
HELENE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
949-416-4670

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  NDF636 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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