1962169482 NPI number — PACIFIC CLINICS

Table of content: ANNA ELIZABETH BREEDLOVE CRNA (NPI 1457940157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962169482 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:
1962169482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 LLEWELLYN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95008-1940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-379-3790
Provider Business Mailing Address Fax Number:
408-364-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
STE 125 & STE 300
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-441-4221
Provider Business Practice Location Address Fax Number:
626-441-6479
Provider Enumeration Date:
11/18/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCARTHY
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER / PRESIDENT
Authorized Official Telephone Number:
408-379-3790

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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