Organization
WESTERN PACIFIC MED-CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HICKMAN (C.E.O.)
(818) 956-3737
Entity
Organization
Contact information
Practice address
955 E THOMPSON BLVD, VENTURA, CA 93001-3008
(818) 956-3737
Mailing address
4544 SAN FERNANDO RD, SUITE 202, GLENDALE, CA 91204-1987
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
56-08
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5613
DRUG MEDICAL PROVIDER
CA
01
—
HDC70062F
MEDICAL PROVIDER
CA
Enumeration date
02/13/2007
Last updated
09/28/2015
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