Provider Demographics
NPI:1699802215
Name:UNIVERSITY OF THE PACIFIC
Entity type:Organization
Organization Name:UNIVERSITY OF THE PACIFIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST DEAN, BUDGET & FIN ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-351-7192
Mailing Address - Street 1:1203 J ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3331
Mailing Address - Country:US
Mailing Address - Phone:510-489-5200
Mailing Address - Fax:
Practice Address - Street 1:1203 J ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3331
Practice Address - Country:US
Practice Address - Phone:510-489-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF THE PACIFIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01001-06OtherDENTI-CAL IDENTIFICATION