Provider Demographics
NPI:1902209992
Name:PACIFIC HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:PACIFIC HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-240-0006
Mailing Address - Street 1:319 S BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1701
Mailing Address - Country:US
Mailing Address - Phone:818-240-0006
Mailing Address - Fax:818-240-0038
Practice Address - Street 1:319 S BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1701
Practice Address - Country:US
Practice Address - Phone:818-240-0006
Practice Address - Fax:818-240-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113904261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health