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Organization
PACIFIC DIAGNOSTICS
Active
Organization
PACIFIC DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYN JARALD HENDERSON D.O. (PRESIDENT/OWNER)
(714) 741-0622
Entity
Organization
Contact information
Practice address
13312 EUCLID ST, GARDEN GROVE, CA 92843-2514
(714) 741-0622
(714) 741-0623
Mailing address
17853 SANTIAGO BLVD, #107-489, VILLA PARK, CA 92861-4113
(714) 741-0622
(714) 741-0623
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A4401
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX44010
—
CA
05
—
00AX44011
—
CA
Enumeration date
06/17/2006
Last updated
08/22/2020
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