Provider Demographics
NPI:1851414189
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:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-946-2132
Mailing Address - Street 1:3601 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95211
Mailing Address - Country:US
Mailing Address - Phone:209-946-2132
Mailing Address - Fax:209-946-2284
Practice Address - Street 1:405 E PINE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5522
Practice Address - Country:US
Practice Address - Phone:209-946-2132
Practice Address - Fax:209-946-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90441OtherMEDI-CAL
CA90432OtherMEDI-CAL