Provider Demographics
NPI:1730266719
Name:PACIFICA OF THE VALLEY CORPORATION
Entity type:Organization
Organization Name:PACIFICA OF THE VALLEY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-827-3986
Mailing Address - Street 1:9449 SAN FERNANDO ROAD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352
Mailing Address - Country:US
Mailing Address - Phone:818-767-3310
Mailing Address - Fax:818-252-2291
Practice Address - Street 1:14228 SARANAC LN
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1435
Practice Address - Country:US
Practice Address - Phone:818-767-3310
Practice Address - Fax:818-252-2291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFICA OF THE VALLEY CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSM30378HMedicaid