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Organization
PACIFIC PSYCHIATRY INC.
Active
Organization
PACIFIC PSYCHIATRY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MICHAEL RIVARD M.D. (PRESIDENT)
(805) 541-5055
Entity
Organization
Contact information
Practice address
3220 S HIGUERA ST, SUITE 215, SAN LUIS OBISPO, CA 93401-6987
(805) 541-5055
(805) 541-5075
Mailing address
3220 S HIGUERA ST, SUITE 215, SAN LUIS OBISPO, CA 93401-6987
(805) 541-5055
(805) 541-5075
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C2754748
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2754748
CORP RESGISTRATION #
CA
01
—
FNP33987
FICITITOUS NAME PERMIT
CA
Enumeration date
08/24/2007
Last updated
08/24/2007
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