Provider Demographics
NPI:1982414983
Name:PACIFIC HEALTH CLINIC INC
Entity type:Organization
Organization Name:PACIFIC HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR. CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-666-1636
Mailing Address - Street 1:1040 DAVIS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1513
Mailing Address - Country:US
Mailing Address - Phone:510-686-1122
Mailing Address - Fax:
Practice Address - Street 1:1040 DAVIS ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1513
Practice Address - Country:US
Practice Address - Phone:510-686-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty