| Organization Name: | WESTERN PACIFIC MED-CORP |
| NPI Number: | 1003958976 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK HICKMAN (C.E.O.) |
| Mailing Address: | 955 E Thompson Blvd Ventura |
| State: | CA US |
| Postal Code: | 930013008 |
| Phone Number: | 8189563737 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2007 |
| NPI Last Update Date: | 09/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2800X |
| License Number: | 56-08 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Methadone Clinic |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |