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Organization

WESTERN PACIFIC MED/CORP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARK HICKMAN (CEO)
(818) 956-3737
Entity
Organization

Contact information

Practice address
4632 SAN FERNANDO RD, GLENDALE, CA 91204-1822
(818) 956-3737
(818) 543-6767
Mailing address
4632 SAN FERNANDO RD, GLENDALE, CA 91204-1822
(818) 956-3737
(818) 543-6767

Taxonomy

Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
CMM70045F
CA
05
CMM70047F
CA
05
CMM70054F
CA
05
CMM70074F
CA
05
CMM70208F
CA
05
HDC70023F
CA
05
HDC70028F
CA
05
HDC70061F
CA
05
HDC70062F
CA
05
HDC70063F
CA
Enumeration date
08/07/2007
Last updated
09/05/2007
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