Provider Demographics
NPI:1386352466
Name:PACIFICA FOUNDATION LLC.
Entity type:Organization
Organization Name:PACIFICA FOUNDATION LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-913-4914
Mailing Address - Street 1:1300 N VERMONT AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6086
Mailing Address - Country:US
Mailing Address - Phone:323-913-4524
Mailing Address - Fax:323-913-4826
Practice Address - Street 1:1300 N VERMONT AVE STE 407
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6086
Practice Address - Country:US
Practice Address - Phone:323-913-4524
Practice Address - Fax:323-913-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty