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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
218 E COMMONWEALTH AVE, FULLERTON, CA 92832-1911
(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
30-11
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3099
DRUG MEDICAL PROVIDER
CA
01
CMM70208F
MEDICAL PROVIDER
CA
Enumeration date
02/13/2007
Last updated
09/28/2015
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