Individual
JACK PAVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9411 SUNNYSIDE AVE, BEN LOMOND, CA 95005-9345
(831) 252-1114
Mailing address
9411 SUNNYSIDE AVE, BEN LOMOND, CA 95005-9345
(831) 252-1114
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
RHF00105782
CA
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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