Organization
PACIFICA HEALTH SERVICES LLC
Active
Other names
Pacifica Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN PHILIP WOLNERMAN RPH, FASCP (OWNER)
(515) 285-2559
Entity
Organization
Contact information
Practice address
4911 SW 19TH ST, DES MOINES, IA 50315-4487
(515) 285-2559
(515) 285-6487
Mailing address
4911 SW 19TH ST, DES MOINES, IA 50315-4487
(515) 285-2559
(515) 285-6487
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
770692
IA
261QP2000X
Physical Therapy Clinic/Center
Primary
770692
IA
261QX0100X
Occupational Medicine Clinic/Center
770692
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0807321
—
IA
Enumeration date
06/18/2009
Last updated
06/18/2009
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