1225374069 NPI number — PACIFIC ASIAN COUNSELING SERVICES

Table of content: (NPI 1225374069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225374069 NPI number — PACIFIC ASIAN COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC ASIAN COUNSELING SERVICES
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:
1225374069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4427 W 138TH ST # A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWTHORNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90250-6909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-531-4627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8616 LA TIJERA BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-3945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-337-1550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MANZANO
Authorized Official First Name:
JOYCELYN
Authorized Official Middle Name:
Authorized Official Title or Position:
HR
Authorized Official Telephone Number:
310-337-1550

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  171M00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 171M00000X , 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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