| Doctor Name: | JACK PAVICH |
| NPI Number: | 1467825703 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | RHF00105782 |
| Business Practice Address: | 9411 Sunnyside Ave Ben Lomond, CA - 950059345 |
| Business Phone Number: | 8312521114 |
| Business Fax Number: | |
| Mailing Address: | 9411 Sunnyside Ave, BEN LOMOND |
| State: | CA |
| Postal Code: | 950059345 |
| Phone Number: | 8312521114 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2015 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | RHF00105782 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |