Organization
PACIFICA MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN POLUCHA (OWNER)
(949) 677-7523
Entity
Organization
Contact information
Practice address
24192 MIMOSA DR, LAGUNA BEACH, CA 92677-7000
(949) 677-7523
Mailing address
24192 MIMOSA DR, LAGUNA BEACH, CA 92677-7000
(949) 677-7523
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2756954
CA
Other
Enumeration date
09/25/2007
Last updated
09/25/2007
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