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
10751 DALE AVE, STANTON, CA 90680-2604
(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
30-10
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3098
DRUG MEDICAL PROVIDER
CA
01
—
CMM70074F
MEDICAL PROVIDER
CA
Enumeration date
02/13/2007
Last updated
09/28/2015
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